Digital Media Consent Form

Digital Media Consent Form
To be completed for each identifiable photo/digital media containing the named Child/Young Person.
Name of Child/Young Person

First NameLast Name
Name of Parent/Guardian/Carer

First NameLast Name
Email of Parent/Guardian/Carer
example@example.com
Event applicable for the consent form
Date applicable for the consent form

DayMonthYear
2 digit day, 2 digit month, 4 digit year
No photograph, video, or other visual media can proceed until I as parent/guardian confirm the following statements:
My child/young person consented to the photographs, videos or other visual media being taken.
I consented to the photographs, videos or other visual media being taken.
My child/young person and I know about how photographs, videos or other visual media are likely to be used and where they are likely to be published (e.g. website, social media, approved notice board, newsletter).
I know I can contact Aikido Victoria via the email address aikidovictoria@gmail.com if I am ever concerned about the publication of any photographs, videos or other visual media containing my Child/Young Person. Aikido Victoria will then make every effort to remove said photographs, videos or visual media.
I know that Aikido Victoria cannot control any reposting of their photographs, videos or other visual media once it is published or displayed on an approved dojo notice board.
Is there a particular dojo notice board applicable for this consent form?
Please Note: Dojo notice boards must be first approved by the Victorian Area Representative to be applicable for consent to display.
Expiry date of photo/other visual media on the specified dojo notice board:

DayMonthYear
2 digit day, 2 digit month, 4 digit year
No photograph, video, or other visual media can proceed until I as parent/guardian confirm the following statements:
My child/young person consented to the photographs or other visual media being displayed on the specified dojo noticeboard.
I consented to the photographs or other visual media being displayed on the specified dojo notice board.
My child/young person and I know that the specified dojo is a shared dojo space, and that external parties outside of Aikido Victoria may be able to access and repost these photos without our consent.
My child/young person and I know the expiry date is when the photographs or other visual media displayed on the specified dojo noticeboard are likely to be removed.
My child/young person and I know that the photographs or other visual media displayed on the specified dojo notice board will be de-identified, removed and disposed of before the expiry date.
My child/young person and I know that de-identifying of photographs, videos or other visual media means the removal of a child or young person’s face or other identifying feature that is clearly visible.
Please Note: Photographs, videos or other visual media will be deleted in line with our Digital Media policy.
Declaration of Disclosure & Understanding
I declare that I have read, understood and agreed to the terms of this consent form, and that if I did not understand the terms of this consent form, then I have requested an independent person to explain them to me.
Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Please verify that you are human
Should be Empty:

Digital Media Consent Form

Declaration of Disclosure & Understanding