1300 729 190
contact@ssrg.com.au
About us
Our Team
Locations
Services
Occupational Therapy
Physiotherapy
Speech Pathology
Exercise Physiology
Dietitian
Social Work
Funding
NDIS
Aged Care
Other Funding
Careers
Blog
GET STARTED
Media Consent
I [Talent Name below ] hereby assign and grant Smart Solutions Rehab Group the right and permission to use and publish the photographs/film/video/electronic representations and/or sound recordings made of me on the date below and I hereby release Smart Solutions Rehab Group from any and all liability from such use and publication. I hereby authorize the reproduction, copyright, exhibit, broadcast, electronic storage and/or distribution of photographs/film/video/electronic representations and/or sound recordings without limitation across all media and in perpetuity at the discretion of Smart Solutions Rehab Group, and I specifically waive any right to any compensation I may have.
Written Feedback
(Required)
I agree my written feedback may also be used for marketing purposes, such as testimonials on our website or in social media posts.
Talent Name
(Required)
Talent – Date of Birth
MM slash DD slash YYYY
Address
(Required)
Phone
(Required)
If the person signing is under age 18 years or requires assistance with decision making, the parent or legal guardian/authorized representative must sign below. I hereby certify that I am the parent or legal guardian or authorized representative of the talent named above and I give consent without reservation to the foregoing on behalf of him or her.
Name of representative
Date of shoot
MM slash DD slash YYYY
Images & Attachments
Drop files here or
Select files
Max. file size: 100 MB.
CAPTCHA
