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Proactivity Image Consent Release Form

Please use the form below for your child's Image Consent Release agreement.

I confirm that I am the parent or guardian of the child whose name appears below. On behalf of my child I give Proactivity Pty Ltd, its assigns, successors, licensees, legal representatives, employees and agents (Proactivity), the irrevocable right to use my child’s name/photograph/image/audio recording/video recording and likeness (My Child’s Image) for the purpose(s) set out below (the Approved Purpose).

I waive any interest that I (or my child) may have in the copyright to My Child’s Image now or at any future time and acknowledge that I am not entitled, nor shall in the future be entitled, to receive any payment or consideration in respect of it and agree to make no claim against Proactivity for any payments for use of My Child’s Image for the Approved Purpose.

I further understand Proactivity cannot control unauthorised use of My Child’s Image by persons not associated with Proactivity upon the publication of My Child’s Image. I forever waive any right to inspect or approve any publication of My Child’s Image by Proactivity. I release and indemnify Proactivity from any loss, damage, costs, expense, or claim (including consequential loss) connected with the use of My Child’s Image for the Approved Purpose, including action for defamation, breach of privacy, or copyright.

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Child's Name(Required)

You consent to Proactivity using your child’s image, taken during their recent participation in the Proactivity Program at the event location on the event date, in Proactivity’s promotional materials in whole or in part, for inclusion on Proactivity’s website and social media channels (e.g. Proactivity’s Facebook, Instagram, and YouTube accounts).

Name of Parent / Guardian(Required)
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