To: LYNDA CLOSE of Petrie, QLD 4502

I hereby acknowledge that health and personal information is required to be collected by Lynda Close from me as a condition of my participating in group workshops or individual sessions.

I consent to providing this information and agree that these records may be retained by Lynda Close for the purpose of my future participation. The information will be accessed by Lynda Close and facilitators nominated by Lynda Close from time to time on an “as needs” basis.

It is understood that I may gain access to these records at any time and have the right to change the information contained. I acknowledge that personal information is protected under law & can only be released to someone else where the law requires or where I give my permission.

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