I hereby irrevocably grant to the Timaru District Council, Waimate District Council and Mackenzie District Council permission to use or any work associated with South Canterbury Road Safety and its assignees the full right and permission to use my photographic image in any form of media or for any other lawfulpurpose in relation to any promotion or communication relating to South Canterbury Safety its activities or to any organisation that South Canterbury Road Safety ffunds, sponsors or supports in any way.

I understand and agree that my photographic image may be cropped, altered, transformed orreproduced in any way and may also be combined with other works or text. 

I waive any right that I may have to inspect or approve any product or copy prior to its use. 

I am legally entitled to authorise this use and have read and fully understood the above authorisation.

Draw signature|Type signatureClear

I, ________________________, am the parent/legal guardian of the individual named above, I have read this release, understand and approve of its terms.

Draw signature|Type signatureClear

Contact Details