Image waiver form

Image waiver form - mokopuna

Please complete Te Kōhanga Reo National Trust's image waiver release form to grant permission for the Trust to use photos of your mokopuna.
Parent / guardian*
Contact number*
Email address
Optional
Mokopuna name*
Mokopuna date of birth*

DayMonthYear
Enter date of birth.
Please enter Mokopuna iwi affliations*
Te Kōhanga Reo ID

Declaration
I confirm that I have authority to provide this waiver for {mokopunaName}.

I hereby grant the Trust permission to use photos of my mokopuna specifically, or that feature my mokopuna in the background in any of the following:
Intranet and communications (internal use)
Website (external use)
Print media (internal use)
Print media (external use)
Please check the boxes to confirm you agree.
I understand that at Kōhanga Reo or Trust held events or related activities, my mokopuna may be photographed or be recorded on video.
I agree to allow photos, video, or film likeness of my mokopuna to be used for any legitimate purpose by the Kōhanga Reo or Trust. Neither myself or my mokopuna will receive any financial compensation, including any royalties arising from this.
I understand and agree that photographs / video or film likeness in the possession of the Kōhanga Reo or Trust are the property of the Kōhanga Reo or Trust.
I hereby waive my right to inspect or approve the photographs or video in which my mokopuna appears.

Authorisation
I Name on this Date declare that all information completed in this form is true and correct.
Use your mouse, electronic stylus or pencil to sign below. (Depending on your device).
Signature*

Clear
Review the form to ensure you have completed all relevant fields then click Submit.
Should be Empty:

Image waiver form - mokopuna