Program Registration and Media Consent Form

This form is required to take part in a Disability Sports Australia program.

It includes consent options for media and promotional use, which help us share the impact of our programs.

Your responses also help us understand participation and physical activity levels, supporting reporting requirements and the improvement of future programs.

This program is fully subsidised through the support of our partners, so there is no cost for your child to participate.

I, as named above, consent to Disability Sports Australia and its agents (including but not limited to, any photographer, interviewer, creative agency or media organisation) recording images of me at the event identified above, for promotional purposes. I consent to these images being used by the event organisers and disclosed to any person or organisation approved by the event organisers, including but not limited to, publishing them as part of a book, poster, brochure or report, newspaper advertisement or article, television advertisement or program, radio advertisement and any other media. I agree that the event organisers and their agents may edit the images prior to publication, as they consider appropriate, without first consulting me.

As part of our commitment to enhancing our programs, we are keen to understand the current level of physical activity of participants. Please answer the following question:

How frequently does your child currently participate in sport, recreation or leisure activities?

Note: If you are under 18 years of age your parent / legal guardian must also provide their consent by completing the below section.

Parent / Guardian Consent: I consent to the above on behalf of the child named on this form.

Privacy Statement: The personal information submitted on this form is collected by Disability Sports Australia for consent to the use, disclosure and publication of the above mentioned child’s image. The information will not be disclosed to other parties except where permitted under the Privacy Act 1988.