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Link Wentworth

13 14 21

02 4726 5500

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Media Consent Form

Media Consent Form

Media Consent Form

This form gives your consent for Link Wentworth to use your photo, video, story or interview. You have control over how and where we use this information. Your photo or story could be used on our website, in our Annual Report, on our social media or in an information brochure about Link Wentworth. By ticking the boxes and signing below, you agree to let Link Wentworth use photo/s of you, and/or video footage of you, and/or your story for these purposes or similar. Please read the conditions carefully and get in touch if you would like more information or assistance. Phone 13 14 21 or email communications@linkwentworth.org.au NOTE: If you are under 18 years of age, you will need a parent or guardian to review and sign this form for you.

Name(Required)
Name of parent or guardian (if applicable)
Email(Required)
I consent and agree that a representative of Link Wentworth Housing has permission to take photographs and/or video footage of me.(Required)
I consent and agree that Link Wentworth Housing has permission to use photographs of me or use my story in print materials for promotional, educational, reporting, training and/or commercial purposes. This includes materials such as annual reports, tenant handbooks, brochures, pamphlets and flyers to promote Link Wentworth and its services.(Required)
I consent and agree that Link Wentworth Housing has permission to use photographs and/or video footage of me and/or my story in digital form and/or online for promotional, educational, reporting, training and/or commercial purposes. This includes having my picture shared on Link Wentworth’s social media channels and website to promote Link Wentworth and its services.(Required)
I consent and agree that Link Wentworth Housing has the permission to share photographs/video footage of me or my story with external media and partners. (Please note: You will be notified if Link Wentworth plans on sharing your image with external media.)(Required)
I consent and agree that these photographs or video footage of me or my story can be used by Link Wentworth Housing for a period of up to five years. You can withdraw your consent by emailing communications@linkwentworth.org.au, calling 13 14 21 or posting your request to PO Box 5124 Chatswood West NSW 2067 and we will consider your request.(Required)
I understand that I will receive no payment for the use of the photographs and/or digital footage and/or interviews taken by Link Wentworth Housing.(Required)
I am over the age of 18 years old or a parent or guardian over the age of 18 years old has authorised on my behalf.(Required)
Clear Signature