Photography/Video Consent Form

Swim With Jo Photography/Video Consent Form

FACILITY DATE

Name & Address

Telephone No Reason or use of images

Who will be using the picture and who will be viewing?

Names of Subjects

Relationship to Subjects

Date & Time Of Use Following DPA 1988 customer consent is required and where children are involved parental consent must be sought please use box below if relevant: Customer Name Customer Signature (Parents of child)

Use of photography and recording equipment including mobile phones is forbidden in the following areas: showers, all changing rooms and toilet areas. If any customer complains or expresses concern, you must respect their rights and you will be asked to stop taking photographs or recording. Declaration I, the undersigned, agree that the information provided is valid and that the images will only be used for the reasons given. Signed: ______________________ Print: ______________________