Event Recording and Media Consent

Optional form for identifiable promotional use

Legal entity — Church of Channeling and Spiritual Healing Limited ABN / ACN — 12 690 056 672 / 690 056 672

Registered address — 52 Narooma Drive, Ocean Shores NSW 2483, Australia

Effective date — 01/07/2026

Participant details

Full name Event

Event date

Email

Parent/guardian (if under 18)

Consent

I consent to Church of Channeling and Spiritual Healing Limited capturing and using my identifiable image, voice and/or written testimonial for the selected purposes below.

• ☐ Internal archival and training use

• ☐ Church website and member communications

• ☐ Social media and public promotional materials

• ☐ Paid advertising

• ☐ Use of my first name

• ☐ Use of my full name

I understand that consent is voluntary and is not a condition of receiving ordinary services unless recording is essential to the particular program and clearly disclosed before purchase.

I may withdraw consent for future use by written notice. Withdrawal will not require recall of materials already lawfully published or distributed, although the Church will take reasonable steps regarding future controlled use.

The Church will not materially alter my words in a misleading way or imply a medical or guaranteed outcome.

Signature

Participant signature Parent/guardian signature (if applicable)

Date