Youth Media Consent Form

By completing the below form, I hearby give my consent for the St Vincent de Paul Society, or approved media or agents to use any interviews, photos or video obtained. I understand that these interviews or images may be used by media outlets approved by the Society or by the St Vincent de Paul Society for their marketing materials and publications. I understand that this material will be kept for an indefinite amount of time and will be stored and disposed of securely. It can also include paragraphs.

I am over 18 years of age. I have read this release and understand what it means.

I am the parent/guardian of the person depicted and I give permission for my child’s image to be used for marketing materials and publications.

Vinnies Contact *

School/University/Organisation/Other (If applicable)

First Name *

Surname *

Date *

Name of child/young person

Email *

Contact phone number *

Signature *

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