TALENT APPROVAL FORM

I hereby give approval for images of me to be used by Curtin University for publishing and/or
promotional purposes relating to Curtin University for five years from this date and indefinitely for
archival and historical purposes.
I understand that Curtin University will not use images of me in an inappropriate manner, and that
images of me will not be used for other purposes without my prior approval.

Approval

I am 18 years of age or older

I am the parent/guardian of the talent and give permission on behalf of my child

D D M M Y Y Y Y

Signature Date

Please print name: ______________________________________________________________

Talent Contact Details

Family name

Given name/s

Address

Student/Staff ID Telephone

Email

Notes

Curtin Use Only

Organisational unit UniLife, Curtin Community Life, Curtin Leadership Centre

Responsible staff member Genevieve Hodge Extension 1080
Date 0 3 0 6 2 0 1 4

Initiating project John Curtin Leadership Academy

Image reference
numbers

Talent description
(clothes/hair/
glasses etc)

Photographer

Curtin University is a trademark of Curtin University of Technology. Security Classification: CRICOS Provider Code 00301J (WA), 02637B (NSW)