Name
School & Year
Email
Mobile/phone contact
Why would you like to do Work Experience at UNSW Science? (Limit: 100 words)
Have you undertaken any extra-curriculum activities involving Science? (Limit: 100 words)
What are your current subjects, and what are the subjects you intend to study at the HSC/Year 12 level?
School Contact Information (Full name & Email address please)
Science Teacher
Careers Advisor


PROJECT: UNSW Science Work Experience 2017 PROJECTDATE27 Nov to 1 Dec 2017

As part of my participation in work experience at UNSW, I will record and make a video which captures my experience. The video may include my image as well as the image of others, and the audio recording of my voice and the voices of others (‘Video’). I understand the Video will remain my property, but that I will provide a copy of the video to THE UNIVERSITY OF NEW SOUTH WALES (“UNSW”), for its use in accordance with this release form.

I agree to UNSW, including its related entities and agents, using, reproducing and adapting my Video and publishing, promoting, distributing and exploiting my Video, for UNSW’s educational, promotional, marketing and editorial purposes.

I further agree that UNSW may use and re-use and allow others to use, for an unlimited period, my Video (including, if applicable, my voice and likeness) alone, in part and in composite form and in any current or future medium, including but not limited to print, electronic and broadcast media. I agree that I am not entitled to any remuneration for granting UNSW the right to use my Video, or in the event that UNSW uses my Video in accordance with this release.

I agree that the Video I make will be original and is available for use by UNSW as contemplated by this release, and that I will obtain permission from any identifiable person or persons who appear in the Video to using their image and submitting the Video to UNSW for its use as contemplated by this release.

I warrant that any statements made by me in my Video will be to the best of my knowledge true and that neither those statements nor my Video will be unlawful or will violate or infringe upon the rights (including copyright, trade mark and other intellectual property rights) of any other person or entity.

I waive any and all rights of attribution and any and all rights to inspect or approve UNSW’s finished content (including photographs, video, audio, printed or electronic matter derived from my Video) that may be used by UNSW now or in the future, whether that use is known to me or unknown, in connection with any use of the rights granted above relating to my Video.

AGREED AND ACCEPTED

NAME

(PleasePrint)(Signature)

ADDRESSDATE

CITYPOSTCODE

PHONEEMAIL

If the person in the Appearance who has signed this release and consent is under 18 years of age, this Release must also be agreed to by the Parent or Guardian of the person appearing.

I am a parent (or guardian) of the person in the Appearance who has signed this release and consent, and I hereby agree that I and the said person appearing will be bound by all the provisions contained herein.

NAME

(PleasePrint)(Signature)

DATE

UNSW staff to send completed form to UNSW Records Office for filing in File No. 2009/3402