Date : ____________
Location : _________________________
Start Time: _________ End Time: ________
In connection with my voluntary involvement in activities undertaken with *organisation name*_____________ and *company name* __________________ I declare that I am fit to volunteer, that I have read and understood the risk assessment and that I consent to my image being used for the purposes stated in the Photo Release. I hereby attest that my attendance and involvement is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release.
NAME | SIGNATURE | FIT | RISK | MEDIA |
---|---|---|---|---|
Please print clearly | Please mark to consent | Please mark to consent | Please mark to consent | |