Fiz FairfieldCity Celebrating diversity Photography and Video Adult Consent Form Fairfield City Council regularly reproduces photographs/video of people in its various publications, marketing material, newspapers, website and on social media for promotional and educational purposes. Fairfield City Council would lke to be able to use and reproduce one or more photographs and/or video footage of you for these purposes and is seeking your consent to do so. If you agree to us using photographs/video footage of you in this way, please complete and sign this form Are you over the age of 18? OYes LINo May we take photographs/video of you? Yes [No May we use your image/s in Council publications, online and in news? Yes [No May we print your name with your image/s? Yes LINo | agree to Fairfield City Council using and reproducing photographs/video footage of me for promotional purposes in its publications, marketing materials, newspaper and online (website and social media) Name: Contact number: Address: Email: Signature: Date: Photographer Description of photograph: FAIRFIELD CITY COUNCIL | 97250222 | 86 Avoca Road, Wakeley 2176 | wwwfairfieldcity.nsw.gov.au