Multimedia Photography & Video Consent Form

Person Completing the form is: *

I,

Participant/Parent/Guardian Name: *

give permission for myself / my child's photographs or videos taken as part of my care and support program, to be used now or in the future for the purpose of external communications, including advertising and marketing as well as posted on the service's Social Media account(s) including the Reliability Support & Care Services Facebook account and website.

I understand I can withdraw the above consent at any time by advising Reliability in writing or by email at admin@reliabilitycare.com

Participant's Name: *

Home Address: *

Would you like an email copy of this form? *

Participant's Email Address: *

Would you prefer to sign or upload a digital signature? *

Please Upload Your Digital Signature: *

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Participant/Parent/Guardian's Signature: *

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Date: *