YLab x VicHealth Co-design Training Consent Form

This is a consent form for stakeholder interviews to inform YLab’s VicHealth Co-design Training. If you are unsure about any of the questions, reach out to Grosvenor Francis at grosvenor.francis@ylab.global

Consent

My story, image and voice is my own and I give permission to the Foundation for Young Australians (FYA) to collect information about me as part of YLab’s VicHealth Co-design Training by:

Interviewing me online
Taking an audio recording of me
Taking video footage / film of me

Please type your initials to accept FYA's collection of your personal information.(Required)

Use and Sharing

I decide how other people use and share my story, image and voice. I agree that the information collected from me may be used by FYA:(Required)

For activities related to YLab’s VicHealth Co-design Training

I agree that the information collected from me may be shared:(Required)

With VicHealth, de-identified and in summary form

Privacy

More information about how FYA collects, uses, stores and discloses personal information, and how you can correct or make a complaint about how we have handled your personal information, can be found in our privacy policy: fya.org.au/privacy

Please type your initials to confirm that you understand that your information will be managed in a way consistent with FYA’s privacy policy.(Required)

First Name(Required)

Last Name(Required)

Date(Required)