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Media Release Form

Introduction

By signing The Healthy Mummy Media Release Form you grant permission to The Healthy Mummy to use your name, image, testimonial, video, or sound recording for promotional, commercial, or marketing purposes.

I hereby:

  • Give my consent to The Healthy Mummy to use my name, image, testimonial, video or sound recording, or any adaptations thereof, in any print or electronic medium now or hereafter known world-wide for promotional, commercial, or marketing purposes.
  • Assign to The Healthy Mummy the ownership of any name, image, testimonial, video or sound recording taken of or created by me and grant The Healthy Mummy a royalty free licence to use them as outlined in this release form.
  • Waive any rights, claims, or interest I may have to control the use of my name, image, testimonial, video or sound recording in any promotional, commercial, or marketing material.
I understand:
  • That I will not receive any personal compensation, payment, or any form of renumeration, residuals, or royalties in respect to the of use of my name,  image, testimonial, video or sound recording now or in the future, outside of that which has been agreed to with The Healthy Mummy, and waive any claim to such payments.
I warrant:
  • That if my name, image, testimonial, video or sound recording includes any copyright material belonging to other people, I have permission from the copyright owners to use, and to allow The Healthy Mummy to use that material.
Modification or withdrawal of consent
  • You can modify or withdraw your consent in writing at any time to The Healthy Mummy’s customer support team here. However, any changes to the use of your name, image, testimonial, video or sound recording will only apply from the date The Healthy Mummy receives your withdrawal or modification of the consent. Any existing material in which your name, image, testimonial, video or sound recording is used will not be withdrawn from use and publication.
Privacy information
  • The Healthy Mummy is required to comply with the Privacy Act 1988 in relation to the collection, use, storage, security, and disclosure of personal information. 

Definitions

The Healthy Mummy

The Healthy Mummy refers to The Healthy Mummy Pty Limited (ACN 153 827 751) and/or its representatives, agents, successors, and related entities.

You / Your / I / My

You / Your / I / My includes you, your child or any individual for whom you have authorised decision making responsibility.

Image, testimonial, video or sound recording

An image, testimonial or sound recording referred to in this release form includes but is not limited to photographs, audio, video, written statements or accounts, transcriptions of sound recordings and any adaption thereof of you, your child or any individual for whom you have authorised decision making responsibility.

Media Release Form

Name(Required)
Email(Required)
Address(Required)

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