Released by: Full name: Address: State: Telephone: Mobile: Email address: DOB (Optional): Postcode: (the subject/legal guardian) in favour of: Griffith University, a body corporate pursuant to the Griffith University Act 1998, of Kessels Road, Nathan, Qld (the University) Executed as a Deed SIGNATURE: Witness’ signature Witness’ name (please print) Date: Complete this box only if the subject is under the age of 18 years..
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