Photography and Multimedia Permission Form

Photography and Multimedia Permission Form

Photography, multimedia and work samples permission form
For adults and children

KidsMatter is an Australian mental health initiative that aims to improve the mental health and wellbeing of children, reduce mental health problems amongst children, and achieve greater support for children experiencing mental health difficulties, and their families. It includes KidsMatter Early Childhood, designed for implementation in preschools and long day care, and KidsMatter Primary, designed for implementation in Australian primary schools.

Part of implementing KidsMatter involves supplying staff and families with related resources and materials, keeping interested parties up to date on the initiative, engaging schools to reflect on their experiences and develop content, and creating public awareness of the importance of children’s mental health and wellbeing.

KidsMatter therefore seeks your consent to use photographic and digital images, video and audio recordings and work samples taken from you or your child for use in the following ways (‘the Agreed Purpose’): publications, newsletters, campaigns, websites, social media platforms, other related methods of promotion, any future editions and variations of the above, and both electronic and printed formats of the above.

Non-return of this form will be taken as a refusal to grant permission, and any record of your (or your child’s) likeness or work must therefore be discarded.

In granting permission to ‘KidsMatter’, you are giving consent to the Australian Government Department of Health and Ageing; beyondblue; the Australian Psychological Society; the Principals Australia Institute; Early Childhood Australia; and those acting under their authority as given by KidsMatter providers in good faith.

Consent

I, acknowledge that I:

am over the age of 18 years OR I am the parent/guarding of the person/s who is under 18 years and have the legal capacity to give consent;

am the individual or the ‘right’ person within the network of kinship and community relationships;

understand that KidsMatter does not guarantee that any photos, digital images, recordings or work samples of the individual who is identified below in the area marked, ‘Name of the Person photographed or who supplied work samples’ will necessarily be used;

understand that copyright in photos, digital samples, recordings or work samples of the individual who is identified below in the area marked, ‘Name of the Person photographed or who supplied work’ will vest in the Commonwealth of Australia;

understand that I will not be given the original of the photos, digital images, recordings or work samples of the individual who is identified below in the area marked, ‘Name of the Person photographed or who supplied work samples’;

consent to KidsMatter giving photos, digital images, recording or work samples of the individual who is identified below in the area marked, ‘Name of the Person photographed or who supplied work samples’ to another Australian Government department or agency or to another under its authority in good faith;

consent to the publication, by KidsMatter, of photos, digital images, recordings or work samples of the individual who is identified below in the area marked, ‘Name of the Person photographed or who supplied work samples’ for the Purpose with any reasonable retouching or alteration;

understand the Agreed Purpose of publication of images, recordings or work samples of the individual who is identified below in the area marked, ‘Name of the Person photographed or who supplied work samples’, including possible use on the Internet and in the media;

consent to the film production company/photographer collecting the images, recordings and work samples of the individual who is identified in the area marked, ‘Name of the Person photographed or who provided work samples’;

consent to KidsMatter and those acting under its authority copying and distributing images and recordings of the individual who is identified below in the area marked, ‘Name of the Person photographed or who provided work samples’ in whole or in part as they deem appropriate for the Agreed Purpose; and

understand that every effort will be made by KidsMatter to respect my (my child’s) moral integrity.

I further acknowledge that my (my child’s) image, voice or work samples may be used:

in association with themes relating to mental health disorders (including ADHD, Autism Spectrum Disorder, anxiety, depression, behavioural problems), and the treatment of mental health disorders;

on high-volume promotional items (including but not limited to brochures, posters, publication covers, websites) for a duration of five years (or longer);

in the ways outlined above on a national scale.

Name of Person/s photographed or who provided work samples:

______

I have read or have had a person read this form to me and know that I will receive a copy of it.

SECTION A

For adults

I, ______(print full name) hereby consent to photographic and digital images and/or audio and visual recordings and/or work samples of myself being used by KidsMatter for the purposes described above.

OR

SECTION B

For parents

I, ______(print full name) hereby consent to photographic and digital images and/or audio and visual recordings and/or work samples of my child(ren),
____________(print full name/s) being used by KidsMatter for the purposes described above.

I DO/DO NOT (please circle) give permission for my child’s first name, age and/or year level and school to be identified (surname will not be published).

AND

SECTION C

School or early childhood centre: ______

Name: ______Phone number: ______

Signed: ______Date: ______

Please tick this box if you identify yourself as an Aboriginal or Torres Strait Islander

Please tick here if you needed assistance in reading this form and that it has been read to you.

Name of person who provided assistance (where applicable): ______

(Please note that the names of individuals listed in this form will not be released in publications or otherwise disclosed by the Department without the prior consent of the individual named or their parent/guardian.)

Note:Personal Information including photos, recordings and work samples must be handled by Australian Government agencies in accordance with the Information Privacy Principles established under s.14 of the Privacy Act 1988 (Cth) (“Privacy Act”). You can see the Principles at the legal information retrieval system owned by the Australian Attorney General’s Department at

The Department makes every effort to comply with the Guidelines for World Wide Websites administered by the Office of the Australian Information Commissioner (available at In particular, the Department makes every effort to comply with Information Privacy Principles 1 to 3, 10 and 11 of the Privacy Act.

You should understand that:

  • the photographs, digital images, recordings and work samples will only be used for the purpose of this project
  • personal information published on the Internet is accessible to anyone with access to the Internet, from anywhere in the world
  • while the contents of the Department’s web site are protected by copyright, once information has been published on the Internet, the Department has no control over its subsequent use and disclosure.

DEPARTMENT OF HEALTH AND AGEING USE ONLY:Image nos:

Any restrictions in use?

Caption:

PHOTOGRAPHER DETAILS

Name: ______Signed: ______Date: ____/____/____

Phone no: ______Address ______

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