Thanks for taking part in our media! Please fill out the below form to give your consent. Activity or eventName of activity or event attended:* Date of filming or photography* MM slash DD slash YYYY Consent statementYou must agree and acknowledge the following: agree to AGPAL, QIP, QIP Certifications, QIP Consulting, CFEP Surveys Australia, CFEP Surveys UK (the AGPAL Group): making images or recordings, whether sound, digital or otherwise, of me; 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 newspapers, magazines, brochures, television advertisements, promotional videos, websites, 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 indefinitely; agree that the rights granted to the AGPAL Group are perpetual and that I will not receive any payment, royalty or other consideration (whether monetary or otherwise) from the AGPAL Group in connection with the making, use or storage of the Images and Recordings; agree to the AGPAL Group collecting, storing, handling, accessing, managing, transferring, using and disclosing personal information about me including but not limited to our name, details and image, in connection with the Images and Recordings or the Promotional Materials; acknowledge and agree that any Promotional Materials which refer to me and, expressly or by implication, are, at the date of publication, made in good faith and are not intended to defame or offend me or bring me into disrepute and, to the best of the AGPAL Groups’s knowledge, are true and correct; agree that the AGPAL Group is the owner of the copyright in the Images and Recordings and the physical Images and Recordings; and acknowledge that I have read and understood this Photo Consent Form and I am signing this Photo Consent Form of my own free will, on the full understanding and comprehension of the terms of this Film/Photo Consent Form. Consent* I agree/consent to the above statements Subject informationFull name* Phone number* Email address* Date of birth* DD slash MM slash YYYY This information is required as a form of identity confirmation and used to secure personal data. This data will be kept private and confidential. Consenting for a minor or a person with a decision-making disability* Yes No Please select yes or noDo you identify as Aboriginal Torres Strait Islander Other cultural group For Aboriginal and Torres Strait Islander peoples Agree I also understand that images of Aboriginal and Torres Strait Islander peoples may appear in printed and electronic material for several years. As someone who has identified as an Aboriginal or Torres Strait Islander persons, I understand that the AGPAL Group will take reasonable steps to prevent the images from appearing on material published after my death. However, I understand and agree that, despite those efforts, the Images may still be published or disseminated.Electronic signatureYou must acknowledge Queensland State Laws will accept this communication as containing my signature within the meaning of the Electronic Transaction (Queensland) Act 2001.* Yes, I acknowledge the Queensland State Laws CAPTCHANameThis field is for validation purposes and should be left unchanged.
