Marketing Consent

Where your information will be used

I grant Guide Dogs the right to use, edit, reproduce and publish information or images featuring me (or a minor in my care). I agree that Guide Dogs may use the information and images for any purpose, including advertising, media, publication and promotion.

If you wish to limit the use of your information or images by Guide Dogs, please specify the purpose for which you consent to Guide Dogs using the images or information below.

Sole purpose:

While all care is undertaken concerning use of your information and images, Guide Dogs does not take responsibility for use of your information or images by third parties (including journalists, media organisations, social media reposting etc).

Who is this form for? * required —Please choose an option—Client — AdultClient — Child under 18Member of Public — AdultMember of Public — Child under 18Supporter — VolunteerSupporter — DonorSupporter — Puppy Raiser — AdultSupporter — Puppy Raiser — Child of family under 18Staff — EmployeeStaff — Contractor or Third Party Provider

The name of the person or department who asked you to complete this form

Your personal details

Address

Street Address * required

Suburb * required

Consent * required I understand that this consent is freely given, without expectation of compensation or other remuneration, now or in the future; and that I may withdraw my consent at any time by contacting Guide Dogs. Otherwise, my consent will remain valid for an indefinite period from the date of signing this form. I certify that I have read and understand this consent form in full.