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Least Restrictive Practice: MHAIDS video footage consent form

Please complete the consent form

Thank you for agreeing to contribute to our project.

We must ask for your permission to use your image and video footage. If you are happy for us to use your image and video content, please complete this release consent form below.

You may request a copy of the image(s) and video footage Te Pou has of you at any time by contacting info@tepou.co.nz. 

If you have any questions about this form, please email communications@tepou.co.nz. 

Te Pou’s privacy policy can be found on our website

The video footage will be used to promote the Least Restrictive Practice programme of work at Te Pou. The footage will be hosted on the Te Pou website and may also appear on social media platforms, such as LinkedIn and Facebook. I understand the following conditions:

  • I will not be paid for the use of photos/footage of me (unless otherwise agreed in writing)
  • I do not agree to any photograph or footage of me being used for any purpose other than what is mentioned above.
  • My personal details will not be shared with any third parties (unless otherwise agreed in writing)
  • I confirm that I am over the age of 18 years.

By signing this consent form you acknowledge that you have sought and obtained appropriate permissions from your employer to participate in this work.

As a courtesy, we will provide you with a copy of the final version of the content before it is published.

If at any stage you want Te Pou to discontinue the use of your material, please contact the team communications@tepou.co.nz to discuss options. Please be aware that printed and distributed material may not be able to be retracted after publication.