Consent Form

Please use this form to let us know how you would like Burnie Works to record and use your photos, audio, video and stories.

Name(Required)

First Last

Phone(Required)

Email(Required)

Who is this consent for?(Required)

Myself (i am over 18yrs)

My child / children (under 18yrs)

Childs full name

Use commas to separate if more than one child is being signed for.

How my information is used

I understand that my photo/audio/video/story will be stored securely within Burnie Works storage system. I understand that they are my own and herby grant permission for Burnie Work to use it under the condition that the following requirements are met:

Photo use

Name use

Voice use.

I consent to my photo/video/audio/story being used for the following purposes.(Required)

Digital platforms (e.g. website, social media)

Print materials (e.g. posters, reports)

Knowledge Collection (e.g. reports, evaluations)

Frequency of use

Request for copies

How my information is used

Subscribe

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