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Media Consent Form
Shockwave Jujitsu
First name
*
Last name
*
Email
*
I DO NOT CONSENT
I do not consent to representatives of Shockwave Jujitsu taking photographs/videos of me at Murrayside Community Centre, Ipswich.
I DO CONSENT
I consent to representatives of Shockwave Jujitsu taking photographs/videos of me at Murrayside Community Centre, Ipswich. I grant Shockwave Jujitsu permission to use the photographs/videos and any reproductions or adaptations of them for fundraising, publicity, reporting, funding applications, and other purposes connected with promoting Shockwave Jujitsu. This may include printed and online publicity, social media, press releases, website use, reports, and funding applications.
Optional: Third-Party Publicity
I also consent to Shockwave Jujitsu sharing photographs/video of me with named funding, charity, community, or public-sector partners involved in supporting the course, so that those organisations may use the images in their own publicity, reports, websites, social media, press releases, and funding-related promotional materials. This may include Active Suffolk, Ipswich Borough Council, Sport England, or other funders/supporting organisations named by Shockwave Jujitsu in connection with the course.
Withdrawal of Consent
I understand I can withdraw consent for future use by contacting
info@shockwavejujitsu.co.uk
, but that materials already shared or distributed may not always be removable.
Signature
Signature
Date
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