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Postal Address Media and Communications Internet PO Box 159 Ph: 07 3205 0555 www.moretonbay.qld.gov.au Caboolture QLD 4510 mbrc@moretonbay.qld.gov.au ABN: 92 967 232 136 Please return this form to: Council Officer’s name: Unit/Department:

Event details: Event name:

Event location:

Subject’s details: Mr Mrs Ms Miss

Name:

Address:

Postal address:

Email address:

Home number: Mobile phone: Work phone: Note: Contact numbers which you provide may be used to update council’s records.

Customer summary:

I, authorise Moreton Bay Regional Council to use the

photograph/videotaping taken of for all publicity purposes including publications,

promotional flyers, new articles, websites, newsletters and magazines. Please note: if your image or the image of your child is published on Council’s website it will be published under

a Creative Commons Attribution Licence, which allows any person to lawfully share, adapt or reuse the image, including for commercial purposes. For more information about this Licence, please see the terms and conditions on Council’s website.

including my image

including an image that I have personally photographed

including the image of my child:

Please supply names, ages and description of child/ren including clothing worn in photo/video:

I have read, understood and agree with the terms and conditions outlined on the reverse side of this form,

Signature: Date:

Office use only Description: __________________________________________________________________ Image Number: ____________ Caption: ________________________________________________________________________________________________ Location where photo taken: ________________________________________________________________________________ Name/s of all people in photograph (including description of placement): ______________________________________________ _______________________________________________________________________________________________________

Privacy statement Moreton Bay Regional Council is collecting your personal information for the purpose of obtaining your consent to use your image for the publicity and promotion of Council and its programs and activities.

Photography/videotaping consent form

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Terms and conditions Use of photographic and video/film consent forms What am I consenting to? By signing this consent form you are giving Moreton Bay Regional Council permission to use your personal information for promotional purposes. Your personal information includes photographs and videos of you, audio recordings and interviews with you. Promotional purposes includes, but is not limited to, public relations, news articles or telecasts, education, advertising, research, inclusion on the Moreton Bay Regional Council website and social media pages, fundraising, or any other similar purpose by Moreton Bay Regional Council and/or its affiliates. Contact numbers which you provide may also be used to update Moreton Bay Regional Council’s records. Who owns the image or recording? Moreton Bay Regional Council owns all copyright in the photo, negative, computer image, or recording as well as the physical photo, negative, computer image or recording. What if I am under the age of 18? If you are under the age of 18 you need your parent of guardian to sign the consent form for you. Release and waiver By signing this consent form you;

• release and discharge Moreton Bay Regional Council, its officers, employees, agents and assigns from any and all liability arising from or connected with the taking, recording, publication or other use of said interviews, photographs, computer images, videotapes, or sound recordings;

• release and discharge Moreton Bay Regional Council, its officers, employees, agents and assigns from any and all liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of the pictures, or in any processing toward the completion of the finished product;

• waive all rights you may have (including rights in copyright) to any claims for payment or royalties in connection with any exhibition, televising, or other publication of these materials, regardless of the purpose or sponsoring of such exhibiting, broadcasting, or other publication irrespective of whether a fee for admission or film rental is charged;

• waive any right to inspect or approve any photograph, video, or film taken by Moreton Bay Regional Council or the person or entity designated it by it;

• agree that all negatives and positives, whether prints, video, film, or sound recording and copyright in those negatives and positives are the property of Moreton Bay Regional Council or the person or entity designated by it, solely and completely;

• declare that you are at least eighteen (18) years of age, you are legally competent to execute this consent form, you understand that these terms and conditions are legally binding and that you have voluntarily signed this consent form; and

• confirm that you have fully informed yourself of this consent, waiver and release before signing it.