TALENT RELEASE (MK002F1)

Central Regional TAFE and the Government of Western Australia seek your consent before using and disclosing images or recordings of you.

I give permission for Central Regional TAFE and the Government of Western Australia to publish written and verbal quotes, photographs, video or audio in which I am depicted for the purposes of promotion and communication in a range of materials, including, but not limited to social media, websites, publications, press stories, banners, brochures and other promotional material.

Name:   First Name*   Last Name*
Email:   Email*
Phone:  Phone Number*
Signature:    Signature
Date:   Date*

If aged under 18, then your parent or guardian must complete the section below.

Parent/Guardian Name:   First Name   Last Name
Email:    Email
Phone:    Phone Number
Signature:  Signature
Date:

Exclude name (please check the box to exclude use of your name):

You can withdraw your consent by providing written notice to marketing@crtafe.wa.edu.au. Once withdrawn, no new publications will be released in which you are reasonably identifiable.

OFFICE USE ONLY

Project title:   Project Title
Brief description of image/recording:   Brief Description
Location and date:    Location and Date
Liaising staff:   Full Name   Signature

Add thumbnail if applicable:

Note: Staff must immediately notify any collaborating Government agencies if consent is withdrawn.

Central Regional TAFE
173 - 175 Fitzgerald Street, Geraldton Western Australia, 6530
Tel (08) 9956 2700
Fax (08) 9921 7705
www.centralregionaltafe.wa.edu.au