Photographic / Media Consent Form - On Common Country

Photographic / Media Consent Form - On Common Country

Acknowledgement

I hereby consent to the collection and use of my personal images by photography or video recording.

I axcknowledge these may be used on the On Common Country & Civil Safety Website, in newsletters and publications as well as distributed to memebers.

I further acknowledge that my image may be used by the staff of On Common Country & Civil Safety and in external media to promote the business's growth and for assessment evidence purposes.

I understand that no personal information, such as names, will be used in any publications unless express consent is given.

I also understand that my consent can be withdrawn at anytime in writing to Civil Safety or On Common Country.
Participant Details

This is the description of your section break.
Are you over 18 years of age?

Are you over 18 years of age? No Yes
Parent or Guardian Name Parent or Guardian Name First Last
Relationship
Parent/Guardian Signature - Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / DD / MM YYYY
Participant Name Participant Name First Last
Participant Signature - Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / DD / MM YYYY