Media Consent

Name: Burnie Brae
Price range: $

Media Consent

At Burnie Brae, we love sharing stories and celebrating the people who make our community so special.

Please complete this form to let us know whether you consent to your image, voice or likeness being used in our website, social media, newsletters, brochures and other promotional materials.

Participation is completely voluntary, and you can update your preferences at any time by contacting us or talking to a team meber.

I give permission for Burnie Brae to take and use photographs, videos and/or audio recordings of me for promotional and communication purposes. I understand these may be edited and published across Burnie Brae's website, social media, newsletters, brochures, advertisements and other marketing materials, without compensation. I understand that I can withdraw my consent at any time by contacting Burnie Brae.

Participant's Full Name

Check if you would like to stay anonymous (note: we only share your first name)

Is the participant a Burnie Brae

MemberClientVolunteerStaff Member

Burnie Brae Staff: if you are completing this form on behalf of a member or client, please include your name below:

Phone

Your contact details will only be used if we need to discuss your media consent preferences or contact you regarding the use of your image, video or story.

Participant's Signature

Are there any platforms or publications where you do not want your photo/video used?

No restrictionsYes (please specify):

If yes to above question, please list:

E.g. I don't want my photo shared on social media

Add photos here

Or here...

Add details to go with the images/video or share your story below:

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Burnie Brae Ltd. | ABN: 39 206 062 402 | ACN: 609 476 637

Phone: (07) 3624 2121
Email: [email protected]
Community Centre
60 Kuran Street, Chermside
Weekdays 8am – 4pm

Media Consent

Media Consent

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