Image Release Form printable pdf download

Image Release Form

IMAGE RELEASE FORM

This procedure must be completed when seeking permission from a third party (learner, student,

stakeholder) to use materials belonging to that party. This may include any of the materials listed

below.

NOTE: STUDENTS UNDER 18 REQUIRE GUARDIAN APPROVAL

Subject details

Name

Date

Address

Contact Details

(phone / email)

Release Statement

I have submitted the following materials to Thornlie SHS and I have either created these

materials or have authorisation to submit these materials.

I grant permission to Thornlie SHS to take, copy, modify and publish these materials, without

needing to notify me. These materials may be classified under the following media forms:

¨ visual / audio images (photographs, digital images, drawings, electronic recordings)

¨ written statements (including but not limited to testimonials, letters, emails or other

written statements)

¨ electronic documents (including but not limited to PowerPoint presentations, Word

documents, Excel documents, PDF documents and emails)

I understand that these materials may be used by Thornlie SHS, and distributed to employees,

trainers / assessors, Thornlie SHS website, educational materials, publications, promotions,

advertising and marketing materials.

Signature

Date

IF A GUARDIAN PLEASE COMPLETE THE FOLLOWING

PRINT NAME:

RELATIONSHIP

TO APPLICANT:

Document

Form

Subject

Image Release

1 of 1

Revision

Issue

Page

Version

Dates

01/12/2016

ONCE PRINTED THIS DOCUMENT IS NOT CONTROLLED

Image Release Form