!

"#$$%&'()#&
ConsenL form Lo be submlLLed Lo, held and reLalned by Sonya MaLheson for a perlod as she deems approprlaLe.
sonya[forum-servlces.com.au
0423 983 313
+,-./-0 1,23 4 +5678

ermlsslon Lo use llkeness, lmage, volce, and performance of chlldren under Lhe age of 18 years.

volunLeers are produclng a shorL promoLlonal vldeo Lo feaLure buslnesses, volunLeers and communlLy
groups, sporLlng organlsaLlons ln newman - 1he pro[ecL ls called Pappynewman. Pappynewman conslsLs
of volunLeers who wlll noL flnanclally galn Lhrough Lhelr lnvolvemenL and dlsLrlbuLlon of Lhe vldeo and
supporLlng maLerlals.

We also wlll be Laklng sLlll phoLographs and wrlLLen lnLervlews from parLlclpanLs Lo collaLe conLenL ln
relaLlon Lo Lhe poslLlves for llvlng and vlslLlng newman. 1he alm of Lhe fllm ls Lo promoLe Lhe Lown as a
greaL place Lo vlslL and Lo llve and show lLs fun slde. 1hls maLerlal wlll be used on publlc webslLes,
lace8ook and anyone's elecLronlc medla noL llmlLed Lo ?ou1ube, prlnLed medla and across onllne soclal
medla ouLleLs Lo an unknown audlence.

9/:;/.0 <,2 $/236..6,-
Pappynewman seeks permlsslon Lo use Lhe followlng:
Medla (phoLo/fllm/audlo recordlng) ln whlch your chlld appears
A wrlLLen commenL made by your chlld
=2>-06-? $/236..6,-
8y compleLlng and reLurnlng Lhls permlsslon form, you are granLlng permlsslon for Pappynewman Lo use:
Any lmage or recordlng of your chlld whlch appears ln a phoLo, fllm and/or recordlng Lo publlsh on
paper and/or webslLes or soclal medla
Any lmage, recordlng or commenLs made by your chlld whlch may ldenLlfy your chlld by Lhelr flrsL
name only.
ermlsslon Lo use llkeness, lmage, volce, and performance of chlldren under Lhe age of 18 years.
ConsenL conLlnues wlLh no Llme llmlL.
&,0/.
AddlLlonal wrlLLen consenL by Lhe parenL/guardlan musL be obLalned by Pappynewman prlor Lo publlshlng
full names of chlldren where Lhey appear ln medla arLlcles.
noL every lLem for whlch permlsslon ls granLed wlll be used.
1he maLerlal wlll be avallable for Lhe 'world' Lo download and use under a CreaLlve Commons llcense. 1hls
llcence ls perpeLual, lrrecoverable, free, worldwlde, non-excluslve and allows for Lhe repllcaLlon,
dlsLrlbuLlon, dlsplay, performance and remlxlng of copyrlghLed work for non-commerclal purposes.

+,-./-0 @2/:;62/8 <,2 >-A B/2.,- ;-8/2 CD A/>2. ,< >?/E
!" $% &'" "() *)%+'&%$,$-$". '/ 01++.2)341& "' 5)")*4$&) "() 16) '/ 1 +1*"$7$+1&"8
l undersLand LhaL by slgnlng Lhls, Lhe sLaLed chlld nor l have any rlghL of recourse Lo any of Lhe volunLeers
or organlsaLlons lnvolved.
l glve permlsslon ln accordance Lo Lhe above Lo publlsh medla and commenLs of:

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1;77 ->3/ ,< 05/ $>2/-0@.EI =;>286>-@.EG HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH

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