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Inala Youth Drop in Space
First Name
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Last Name
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Gender
Date of Birth
Post Code
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Phone
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Country of Birth/Origin
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Language
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Lenth of time in Australia
Visa Details
Consent
I give permission to MDA to collect information and share information with other agencies for the purpose of providing settlement support to me and my family
I give permission for MDA Ltd to share personal information of my family with the Australian Government Department of Social Services as the funding body
I give permission to be contacted in the future for the purpose of providing feedback and to participate in research
I give permission for MDA to use any photos, images, videos and visual recordings, or sound recordings of me or my children produced by or for MDA, along with any wording or other graphics for the purposes of marketing and advertising, media publicity, publication, general display or for any other purposes, for example: MDA publications, MDA training materials, MDA website, Facebook and social media, Instagram, YouTube, media releases authorized by MDA. I understand the images/recordings of me contain my personal information and I give MDA permission to disclose this personal information for the above purposes. I understand the images/recordings may be changed or edited and I will not get to approve the final product. I understand MDA will not pay me for the use of any images/recordings and will not repay me for any costs or damages because of its use. I understand that once images/recordings of me have been put on the internet, MDA cannot control how they are used or shared by other people or entities. I release MDA from all claims in relation to the use images/recordings of me. I am of legal age and have the full legal capacity to sign this form without the consent or knowledge of any other person.
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