Youth Photography Consent Form

Location

Date

Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Email

example@example.com

AboriginalTorres Strait IslanderOther Cultural Group? Please specify:

For parents/legal guardians of children or those with authorised substituted decision-making responsibility (if applicable)

I declare that I am the parent/legal guardian of the following child or children or holder of authorised substituted decision-making responsibility for the following person/s (collectively "the subjects")

Names, ages and descriptions:

I do not allow my name/the subject's names to be used in association with the images or recordingImage use conditions/restrictions...

Image use is subject to the following cultural considerations (please specify):

Image use is subject to other restrictions (please specify):

I agree to Honey Badger Events, its employees, officers, agents and contractors ("Honey Badger Events") making images or recordings, whether sound, digital or otherwise, of me, and the subjects ("Images and Recordings"); and 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 third party websites and social media websites which may be hosted overseas, newspapers, magazines, brochures, television advertisements, promotional videos, websites, CD-ROM or other multi-media, for public relations, promotions, commercial and advertising purposes (“Promotional Materials”); and 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 a Honey Badger Events Library.

I agree that the rights granted to Honey Badger Events under this Photo Consent Form are perpetual and that I will not receive any payment, royalty or other consideration (whether monetary or otherwise) from Honey Badger Events in connection with the making, use or storage of the Images and Recordings.

I agree to Honey Badger Events collecting, storing, handling, accessing, managing, transferring, using and disclosing personal information about me, and the subjects including but not limited to our name, details and image, in connection with the Images and Recordings or the Promotional Materials.

I acknowledge and agree that any Promotional Materials which refer to me and the subjects, 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 subjects or bring me or the subjects into disrepute.

I agree that Honey Badger Events is the owner of the copyright in the Images and Recordings and the physical Images and Recordings.

Authorising Person's Name

First NameLast Name

Signature

Date Signed

Date

Privacy Notice: Honey Badger Events is collecting your personal information in order to seek your consent for images and recordings of your children or the subjects to be used in promotional materials. This information will not be shared with any third party. Your personal information will be handled in accordance with the Information Privacy Act 2009.

Youth Open Mic Photography Consent Form