Client photo and video consent form

I understand that if I give my consent for Lifestart to use an audio and/or visual recording of myself and/or my child for promotional purposes, Lifestart may:

• use my name and/or my child’s name (only first names will be used unless otherwise agreed), quotes
  from interviews (or excerpts of such quotes), and my/my child’s image or likeness and voice.
• edit or change the recording in any manner without limitation for the purpose of the recording.
• broadcast, distribute and publish the recording in any medium, including (but not limited to) all print media, free and pay television, Lifestart website, social media, radio, posters and billboards.
• share the recording with third parties approved by Lifestart to use and publish the recording.

You may withdraw your consent at any time by emailing info@lifestart.org.au or phoning 02 9364 0111, however Lifestart is unable to remove images already in use from circulation.