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PHOTOGRAPH AND VIDEO RELEASE FORM I, being the mother/father/guardian of give permission for the use of his/her likeness in a photograph/video captured by CDH Australia for display purposes in both Australian and international media and on the CDH Australia web site, from this date until advised otherwise. I acknowledge that my child/(ren) will be identified by first name only where a name is required. I hereby certify that I am the parent/guardian of and do hereby give my consent without reservation to the foregoing on their behalf. (Parent/Guardian’s Name) (Parent/Guardian’s Signature & Date) Please note: You may withdraw your permission at any time by emailing [email protected] ; however, the use of your child’s image in retrospective media cannot be removed. Withdrawal of permission will only apply from the date the request is lodged.
