Staff and Student Photography Consent Form The Northern Tablelands Local Land Services may take photographs of events and activities that include your students. Before we participate in an activity, can you please fill out this photography consent form and include the children’s names that have prior parental consent to have their photo used for promotional purposes. Please identify those students to Northern Tablelands Local Land Services staff at the activity. I (name) _________________________________________________________________________ of (school name and address) _______________________________________________________ ___________________________________________________________________________ ______ Telephone: _______________________ email: _________________________________________ I agree for my photograph and photograph of the following students to be reproduced in print and electronic format by the Northern Tablelands Local Land Services. Students ___________________________________________________________________________ ____ ___________________________________________________________________________ ____ ___________________________________________________________________________ ____ ___________________________________________________________________________ ____ ___________________________________________________________________________ ____ I understand that: the photograph/s may be used more than once in a variety of Northern Tablelands Local Land Services publications, and in a variety of formats including printed publications and on the Northern Tablelands Local Land Services website. the photograph/s may be sent to media (e.g. newspapers) for publication of any type relating to any Northern Tablelands Local Land Services publicity material. This includes social media (e.g. Facebook). Northern Tablelands Local Land Services A456600

Staff and Student Photography Consent Form€¦ · Web viewStaff and Student Photography Consent Form. The Northern Tablelands Local Land Services may take photographs of events

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Staff and Student Photography Consent Form

The Northern Tablelands Local Land Services may take photographs of events and activities that include your students. Before we participate in an activity, can you please fill out this photography consent form and include the children’s names that have prior parental consent to have their photo used for promotional purposes. Please identify those students to Northern Tablelands Local Land Services staff at the activity.

I (name) _________________________________________________________________________

of (school name and address) _______________________________________________________

_________________________________________________________________________________

Telephone: _______________________ email: _________________________________________

I agree for my photograph and photograph of the following students to be reproduced in print and electronic format by the Northern Tablelands Local Land Services.

Students

_______________________________________________________________________________

I understand that:

the photograph/s may be used more than once in a variety of Northern Tablelands Local Land Services publications, and in a variety of formats including printed publications and on the Northern Tablelands Local Land Services website.

the photograph/s may be sent to media (e.g. newspapers) for publication of any type relating to any Northern Tablelands Local Land Services publicity material. This includes social media (e.g. Facebook).

the full name of myself/my students may be used in some cases to describe the content of the photograph, but will only be done so at the discretion of the Northern Tablelands Local Land Services.

neither myself/school/students will receive any royalties from the Northern Tablelands Local Land Services for the use of any photographs in which I (or my students) appear.

Conditions/ limitations:

My consent is subject to the following limitations (Please tick any/all that are applicable):

None

Cultural considerations, please specify: _______________________________________________

_________________________________________________________________________________

Other restrictions/ conditions (e.g. name NOT to be printed), please specify: __________________

_________________________________________________________________________________

Signature: Teacher ________________________________

Date _________________________________

Please return to Northern Tablelands Local Services Staff at registration at the Property Planning Competition field day.

Northern Tablelands Local Land Services A456600

Page 2: Staff and Student Photography Consent Form€¦ · Web viewStaff and Student Photography Consent Form. The Northern Tablelands Local Land Services may take photographs of events

Privacy policy: Northern Tablelands Local Land Services respects your privacy and has adopted the National Privacy Principles. We will only use the information provided in this form for the purpose of processing your consent form. If you have any questions, please call the Communications Officer on (02) 6720 8317.

Northern Tablelands Local Land Services A456600