Child’s Name: ____________________________________ (Child) Centre: __________________________

Adult’s Name: ____________________________________ (Adult) Event/s: __________________________

Contact Number: ____________________________________ __________________________

Staff’s Name: ____________________________________

Event Dates: __________________________

Purpose

Goodstart Early Learning Ltd (Goodstart) seeks to use photographic and audiovisual images to promote Goodstart and early learning
in Australia.

The images are used for promotional purposes of Goodstart, in media, events, showcasing local centres, marketing materials,
corporate publications, websites and centre based communications, such as newsletters. The images may also be used on
Goodstart’s social media pages including but not limited to Facebook, LinkedIn and Twitter.

If you wish to provide consent for yourself or your child to participate please complete and sign below:

Consent

I, _______________________________ (adult’s full name) for myself and/or my child/ren ___________________________________

_______________________________________________________________________________________ (child/ren’s full name/s)

consent to Goodstart photographing or recording me/my child and using the images for the purposes outlined above, and distributing
the images to media to promote Goodstart and its associated activities.

Acknowledgement
I acknowledge that:
 the images may be stored, used, reproduced, modified, adapted, distributed, published, publicly displayed, uploaded or
downloaded in any form or manner, and incorporated into other materials or works in any format or medium provided it is in
accordance with the consent above;
 This consent is for an indefinite period of time;
 Goodstart may continue to use the images; for an unknown period of time unless and until I give notice in writing that I no
longer wish my or my child’s images to be used, and this will have effect from the date of my notice only and not apply to any
previous use of the images;
 Images may appear on promotional material on the internet making it available worldwide;
 There will be no financial or other remuneration for the images;
 My or my child’s full name may be revealed therein or by descriptive text or commentary to the images; and
 All original copies and digital reproductions of the Records remain the property of Goodstart.
Signed: ______________________________________________ Date: ____________________________________

Please return completed form to your Goodstart Centre Director or the Goodstart Early Learning CAMCO team at
marketing@goodstart.org.au .

For Goodstart Early Learning use only:

Source/centre of photograph/video: _____________________ Purpose of material (name of project/media event): _____________________

Material ID: _____________ ____________ Date of entry: _________________________ Entered by: _____________________

DOCUMENT NUMBER & TITLE Insert number & title of document

POLICY OWNER Insert title & department of policy owner CONTENT OWNER Insert title & department of content owner
DATE PUBLISHED 01/01/2013 DOCUMENT VERSION v2013 1.1 REVISION DUE DATE 01/01/2013
Ensure you are using the latest version of this policy. You can find it at <<insert_link_to_document_here>>
Warning – uncontrolled when printed. This document is current at the time of printing and may be subject to change without notice.