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Welcome
We would be grateful if you would fill in this form to give us permission to take photos of you or your child and to use these in our printed and online publicity.
6
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1
Name
First Name
Last Name
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2
Phone Number
Area Code
Phone Number
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3
Email
example@example.com
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4
Child's Name
First Name
Last Name
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5
Your relationship to the child
Friend
Guardian
Local leader
Parent
Teacher
Other
Friend
Guardian
Local leader
Parent
Teacher
Other
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6
Do you grant Citizens 4 Change full rights to use the images resulting from the photography / video filming, and any reproductions or adaptations of the images for publicity or other purposes to help achieve our aims. This might include (but is not limited to), the right to use them in our printed and online publicity, social media, and press releases.
YES
NO
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