ADULT CONSENT FOR RECORDING &/OR PUBLISHING

Privacy Statement

The Victorian Government will be promoting the State’s education and early childhooddevelopment programs within Australia and overseas. You have been given this form because you will be participating in an event that we would like to record for future promotional activities.

Photographic, video, audio and/or other recordings will be taken for the purpose of building an image library toshowcase Victorian education and early child development. Recordings may be used in marketing and communication initiatives includingexhibitions and trade show displays, printed collateral, outdoor advertising campaigns andwebsite and e-marketing promotions. Images may be shared with Victoria’s educationnetwork (schools, kindergartens and Victorian Government Departments) for the purposeof promoting Victorian education and early child development.

Copyright Release

I, ______, the adult named below, agree to and providepermission for the photographic, video, audio or any other form of electronic recording ofme for and on behalf of the Crown in Right of the State of Victoria (Department ofEducation and Training).

I acknowledge that ownership of any photographic, video, audio or any other form of

electronic recording will be retained by the Crown in Right of the State of Victoria

(Department of Education and Training).

I authorise the use or reproduction of any recording referred to above for the purposes ofpublishing information materials and resources which promote the initiatives of theDepartment of Education and Training to teachers, parents and thewider community without acknowledgment and without being entitled to remuneration orcompensation. The recording may be used on websites available to the wider community,Victorian government school teachers and staff of the Department of Education and Training.

I understand the nature and the consequences of what is being proposed in the above paragraphs. If there has been any matter of uncertainty, I have sought clarification from either a member of the Communications Division, Department of Education and Training, or some other person that has explained any such uncertainty to my satisfaction.

I understand and agree that if I wish to withdraw this authorisation, it will be my

responsibility to inform the Communications Division, Department of Education and Training, on telephone (03) 9637-2222.

Date ______ / Signature ______
Name (Block letters)
Address
Telephone Number
Name of Organisation
Name of Contact and Telephone Number
(if applicable)

DET 2016