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Parent or Guardian Name*

First nameSurname

Parent or Guardian E-mail*

Contact information

Parent or Guardian Phone number*

Contact information

Location*

County

Description of the Video and name of child

Information about the video including any individuals who appear in the video

Are there any contributors under 18 in the video?*

NoYes

I am the parent / guardian of the persons under 18 in the video*

YesNo

Parent or Guardian's Name*

First NameLast Name

Parent or Guardian's Contact number. *

Contact information

Parent or Guardian's E-mail*

Contact information

Parent or Guardian consent*

I have permission from parent / guardian to send the video

Terms and Conditions*

You agree to Boom Cymru using this image/video on a tv broadcast, online and on social media. Please confirm that you have read and understood the Terms and Conditions below. Note, you can refuse permission to show the material at any time.

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Terms and Conditions

This form shall confirm the terms on which we will make use of the image/video ("The Material").

1. You hereby grant to Boom Cymru and persons authorised by Boom Cymru a non-exclusive licence in perpetuity to record, copy, edit, reproduce, broadcast and transmit all or part of the Material for and/or in connection with the production, promotion, exploitation and/or advertising throughout the world for the entire period of copyright in the Material and all extensions and renewals thereof by all means and in all media whether now known or hereafter discovered or developed.

2. You warrant and represent that you are entitled to grant to us the rights referred to in point 1 and that the exercise of such rights shall not (a) infringe the copyright or any other personal or property rights of any person or be in breach of any statute or regulation, (b) entitle any person to claim any payment from Boom Cymru or from any of our licensees or (c) any persons appearing in the Material have given their consents to enable Boom Cymru to exploit the material in all manner and in all media throughout the world for the full period of copyright.

3. You agree to indemnify us against all and any costs, claims, expenses and liabilities (including, without limitation, legal fees and any sums paid on the advice of Counsel) resulting from a breach by you of any of the terms contained in this form.

4. For more information please refer to Boom Cymru's Privacy Policy

5. These terms and conditions are governed and shall be interpreted in accordance with the laws of England and Wales.

S4C Privacy Notice for Contributors

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