Model Release
I consent to the use of my before, after and progress photos and videos to be used by Loz Life for marketing purposes. Please choose Yes or No, otherwise, let us know if you'd prefer for some media to be excluded by writing your conditions in the box for the third option.
*
Yes
No
I also authorise use of the following information (please tick all that apply - or leave blank if you'd prefer not to share) (optional)
My full name
My suburb
My age
First Name
*
Last Name
*
Address
*
Suburb
State
Postcode
Email
*
Phone
*
Coach's Name
Signature
Clear
Parent/Guardian of Model Signature (if under 18 years of age)
Clear
Submit