PHOTO, AUDIO AND VIDEO RELEASE FORM
Information and Cultural Exchange (ICE) and Penrith City Council (PCC) will take photographs, sound and/or video footage that will be used to document the Story Exchange Project. By completing this form you allow us to further promote the Story Exchange Project, PCC and ICE in the future. I/we hereby consent to the use of photographs, sound and footage taken of myself/my child to be used for future publicity of the Story Exchange Project, publications by Council’s Neighbourhood Renewal Program, Information and Cultural Exchange (ICE) and Penrith City Council. The use of any material documented from this project will be used for, but not limited to: ICE and Penrith City Council websites Media releases to printed press, radio and television ICE promotional material (such as flyers, videos and information brochures) PCCs Neighbourhood Renewal Program promotional materials and presentations.
And may include passing this information to overseas offices.
I wish/my child wishes to be acknowledged as (your name): I warrant that I am the below named person and that there are no restrictions that prevent me from granting this consent, and I agree to hold ICE and other organisations associated with the project, harmless against all rights, actions, suits, claims or demands, including any and all claims for invasion of privacy, infringement of the Undersigned’s right of publicity, any other personal and/or property rights and/or any claims for compensation, and any claims arising from a breach of this warranty.
Signed: Full name: ________________________________ Address: ________________________________
Date:
If you are under 16 years of age please ask your parent/guardian to read the information and sign above. ICE and PCC endeavour to present correct information and represent people and organisations fairly. The Information and Cultural Exchange and Penrith City Council are bound by the National Privacy Principles in the Privacy Amendment (Private Sector) Act 2000.