NDIS Choir Membership

What is this consent for? - This consent form, when completed and signed by you, confirms your agreement for IMPACT Community Services to use images/recordings of you in promotional, marketing and educational materials. Images may be in the form of photographs, video footage or sound recordings and may be used in publications, emails, electronic media, productions or presentations. It also confirms your consent to add your email address to IMPACT’s email newsletters for ongoing promotion of IMPACT services.

While IMPACT Community Services will make all reasonable efforts to ensure that only appropriately authorised persons complete this consent form and sign this authorisation, IMPACT Community Services will not be responsible for circumstances in which it is misled as to the identity and authority of the person signing this form.

What happens to the consent form once it is filled out? - This consent form is placed on file and retained by your associated program/section at IMPACT Community Services. If you request us to do so, a photocopy of this form will be made available to you. Your email address may be added to IMPACT’s email newsletters.

Consent Release - I consent and authorise IMPACT Community Services to take and use any photographs, video or sound recordings of me. And I understand that by agreeing to participate in a filming or recording activity, I am agreeing to do so on the basis that there is no fee payable to me for my participation, and that it may result in photographs, video or sound recording of me being published.

Forms of publications may be newsletters; newspapers; magazines; flyers; electronically and online; social media platforms e.g. Facebook; television or radio.

I acknowledge that I have no rights in the material, nor in a publication, production or presentation that includes the material. I agree that IMPACT Community Services are:

• Not obliged to, and have not represented that they will, publish the material;
• Do not have to identify me as author of any of the material which they do publish or otherwise communicate; and
• May edit the material prior to publication, if they see fit, without consulting me.

Withdraw authorisation - I acknowledge that I am able to withdraw my consent for use of my image as described in this form at any time. Withdrawal of consent must be done in writing. In giving my consent I acknowledge that, once my image or sound recording has been released publicly (e.g. in social media, website, brochures etc.) that IMPACT Community Services will not be able to retrieve these images or recordings. You can unsubscribe from IMPACT’s email newsletters at any time by clicking the “unsubscribe” button at the bottom of the email.

Authorisation - I authorise IMPACT Community Services to take the actions indicated above and use my image / information as described in this form and for the purposes as noted.