ORIGINS Photograph/Video Consent

Thank you for your participation in the Art of ORIGINS Project.
Your permission is required to include your child’s artwork within the project and for possible promotion of the project.

Artwork and images may be used:
- for publications such as Annual Reports, newsletters, fundraising campaigns, brochures, websites, videos, flyers and social media such as Facebook.
- by Joondalup Health Campus and the Telethon Kids Institute's philanthropy and supply partners for the purpose of promoting The ORIGINS Project, the Art of ORIGINS project research and the partnership.
- by the media for the purposes of promoting The ORIGINS Project and its research.
Please complete this form and hit submit for it to be returned to the ORIGINS team.
Please provide the name and age written on your child's artwork
Full name/s of child/children (if applicable)
DOB of child/children (if applicable)
Relationship to child (if applicable)

ParentGuardianGrandparentOther
Phone number*
Email*
First name of the person completing this form*
Last name of the person completing this form*
I hereby give permission for my child/children’s artwork to be included within the Art of ORIGINS project and to possibly be used for the promotion of the project as described above.
Signature*

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Date*

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Thank you for your participation in the Art of ORIGINS Project.