Junior Council consent form

Consent form – Image, Recording and Copyright
Material
Personal details of parent/legal guardian for child/student named below
I,
(insert
name)
Your contact details are for recordkeeping purposes only and will not be published
of
(insert
address)
Phone
1.
Email
For parents/legal guardians of children (if applicable) declare that I am the parent/legal guardian of the follow ing child
Child’s name
N/A
Description
Age
2. agree to the Council of the City of Gold Coast (Council), its employees, officers, agents and contractors:
(a) making Images or Recordings, w hether sound, digital or otherw ise, of me and the Child (“Images and Recordings”)
(b) using, publishing or reproducing the Images and Recordings in any form (in whole or in part) and by any medium, including but
not limited to new spapers, magazines, brochures, televis ion advertis ements, promotional videos, websites, CD-ROM or other
multi-media, for public relations, promotions, commercial and advertising purposes (“Promotional Materials”)
(c) retaining or storing the Images and Recordings (including those incorporated into Promotional Materials), in hard copy or digitally,
including but not limited to, deposit of the Images and Recordings into Junior Council files and Council’s Corporate Image Library
(d) suppling a copy of Images and Recordings upon request, to the subjects appearing in them and any relevant associated
institutions
(e) supplying a copy of the Images and Recordings upon request, to Council’s Local Studies Library for archiv e and his toric al
purposes. Images in the Local Studies Library are made available to the general public
3. agree that the rights granted to Council under clause 2 of this Consent Form are perpetual and that I w ill not receive any payment,
royalty or other consideration (whether monetary or otherw is e) from Council in connection with the making, use or storage of the
Images and Recordings
4. agree to Council collecting, storing, handling, accessing, managing, transferring, using and dis closing personal information about me
and the Child, including our name, suburb, age and image, in connection with the Images and Recordings or the Promotional
Materials. This includes transmission outside of Australia. I understand that I may revoke my agreement to this clause at any time
how ever existing uses of the Images and Recordings and promotional materials w ill not be impacted by this w ithdrawal
5. acknowledge and agree that any Promotional Materials w hich refer to me and the Child, expressly or by implication, are, at the
date of publication, made in good faith and are not intended to defame or offend me or the Child or bring me or the Child into
disrepute and, to the best of Council’s know ledge, are true and correct
6. agree that Council is the ow ner of the copyright in the Images and Recordings
7. acknowledge that a representative of Council has explained the contents of this Co n s e n t Form to me and I am signing this Consent
Form of my ow n free will, on the full understanding and comprehension of the terms of this Consent Form
8. agree that Council may use and/or disclose that image or recording of you or your child for City promotions or operational purposes
9. agree that Council may use copyright material, including w ritten, artistic, musical w orks and video or sound recordings created by you or your
child for promotional or operational purposes (see reverse for details).
Signed by
Parent/
Guardian name
Student name
Parent/ Guardian
signature
Student signature
Date
Date
Office use only
Activity:
City of Gold Coast Junior Council Program
2016
Photographer
City of Gold Coast staff or
contractors
Project officers:
Donna Matulis/Elizabeth Hermanoczki/
Brooke Denholder
Period of Image or
Recording or
Copyright material:
1/1/2016 to 31/12/16
Directorate/Branch:
Safe and Liveable Communities
Location of shoot
Various
#52295336
Page 2
5/1/16
Consent Information
Purpose of this form
This form is to be used when Council staff are required to gain permission from an individual to use and/or disclose
their image or a recording of them and copyright material in accordanc e with Council’s Information Management and
Information Privacy Policy. Note: exemptions may apply for law enforcement and public safety activities. Individuals are
encouraged to read the following conditions before, or as soon as possible aft er, Council staff capture an image or
recording of an individual whose identity can be determined from the image or recording. At Council events the use of
this form should be supplemented by signs or public notices advising that an individual’s image or a recording may be
captured and used for Council purposes.
Why do I need to sign a consent form?
Council complies with the Information Privacy Act 2009 (IP Act). Your image or recording is your personal informat ion.
When Council collects personal information, it aims to inform you of the reason, how it will be used and who will have
access to the information. Council asks for your written consent to confirm that you understand and agree with these
provisions.
You can withdraw your consent by contacting Council. Your withdrawal of c onsent will only apply from t he date that
Council receives your request. Existing material containing your image or a recording of you may not be amended if
Council is currently using that material or it is subject to contractual obligations. Council will not attribute names to
images or recordings unless Council considers it to be appropriate.
What is copyright material?
An individual’s copyright material may include written works (e.g. stories and poems ), paintings, pictures, drawings,
designs, ideas, phot ographs, film and music created by them or to which they contributed as part of their participation
in the Junior Council program. Council understands that the student shall ret ain the intellectual property rights of the
material they create and that this consent form is not meant to trans fer the individual ownership of the intellec tual
property of the copyright material.
What will happen to my image/recording/copyright material?
Council will securely store your image/recording in a digital form along with the signed consent form. Your image,
recording and copyright material cons ent becomes a Council record to be managed in accordance with the P ublic
Records Act 2002.
How will my image/recording/copyright material be used?
Your image, recording and copyright will be used for the purposes that you have agreed to on this form. It will not be
used for any other purpose unless you give furt her consent or Council is required to do so by law. Your image or
recording may be used to promote Council’s services, events and programs through Council’s annual report,
brochures, media releas es, newspaper articles, training products, website material and television broadcasts. It may
also be used for business and operational purposes, which includes infrastructure planning, ensuring public safety,
community services development and future planning for the Gold Coast.
Who will have access to my image/recording/copyright material?
Your image/ recording will only be disclosed to authorised people or agencies acting on behalf of Council to achieve the
purpose that you have agreed to on this form. It will not be disclosed to any other person apart from other subjects in
the photos, unless you give further consent or Council is required to do so by law. Any record held by Council is subject
to the provisions for disclosure under the Right to Information Act 2009.
Privacy Notice: Council is collecting the information on this Consent Form in order to use Images and Recordings of you or the Child in
Promotional Materials for Council and as otherwise stated above. Some of this information may be provided to Council employees and Councillors
of Council, as authorised users of Council’s Image Library and for the purpose of using Images and Recordings of you and the Child in
Promotional Materials or for historical and archive purposes. Council may provide these to the other people in them for their own personal use,
otherwise your information will not be given to any other person or agency unless you have given us your consent or we are required or permitted
by law.