Name: QEC
Price range: $

We would like your permission to use your written feedback and/or video, photographs and audio of you and/or your child/ren.

These recordings may be published in the public domain, including (but not limited to):

Online (such as website, social media pages)
Mainstream media (such as television, newspapers, radio)
Written publications (such as reports, journals)
During education and training sessions to QEC staff and external parties.

By signing this form:

I acknowledge that QEC is not bound to make use of the recordings listed in this form
I acknowledge that there is no entitlement for me (or my child) to remuneration, royalties or any other payment from QEC in respect to use of these recordings
I acknowledge that neither my child, nor I have any claim to copyright in any aspect or portion of these recordings.

First Name

Last Name

Date of Birth

Event / Video Name

Date of Photo / Video

Child's Name

Child's Date of Birth

Consent Notes (optional)

I hereby authorise QEC to make use of still/moving images or audio of myself and/or children:

Signature