Y Queensland Asset Authorisation and Release Form

Y Queensland Asset Authorisation and Release Form

PERMISSION TO USE ASSETS FOR MARKETING AND PROMOTION OF Y QUEENSLAND (To be completed and signed by persons 18 years and over)
For Y Queensland to continue to serve the community, it is important to be able to share stories about those who have been impacted by our work. We hope you will consider giving us permission to share your experience, story, feedback or comments
I am completing this form to authorise and release the use by Y Queensland of the assets (photographs / video / audio / artwork / name / personal story) of:*

MyselfMy child or a child under my care
Child's Name*

First NameLast Name
Child's DOB*

MonthDayYear
Date
Parent/Guardian authorisation*

I warrant that I am either a parent or guardian of the person under 18 named above and have the authorisation to provide this authority.

Reference Photo

Optional
Please upload a photograph of the individual whose assets this form is regarding.

(This is particularly important if you do not authorise the use of assets. The photo will remain internal and kept safely in accordance with the Y Queensland Privacy Policy.)
Photo Upload

Cancelof

	Yes	No
Their own internal use
Public channels in their state, territory, or nationally

Asset Authorisation