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(One copy is to be kept by the person signing, one copy by the organisation)

 

I, …………………………………………………… of

………………………………… ……………………………………………………………………………………………

hereby give my permission to ……………………………………………………

(the organisation) to use the following

personal information,

photographs

video footage in publications and public relations activities. I am aware that this may be printed in publications and/or promoted by electronic media, including the Internet.

They may appear in: newsletters, bulletins, journals and books, Intranet and Internet sites, external publications such as newspapers and magazines, promotional publications, such as posters, brochures, booklets and displays, television segments, conference papers and presentations. For the purposes of the Privacy Act 1988, these are classified as generally available publications. The photographs and/or videos may also form part of reports to the funding body, the Commonwealth Department of Family and Community Services, or other funding bodies (list here if applicable).

 

I understand that I may withdraw my consent to publish the above information at any time and as a result the …………………………………………………………………………(the organisation) will arrange for this information to be removed from all future printed publications and withdrawn from the electronic media, including the Internet.

Signature ……………………………………………………… Date …………………

Thank you!

Please give this form to your SFLEX project worker.