This Girl Can Campaign – Video and Photo Consent form with Copyright Licence

Thank you for providing your photograph(s) and/or video footage (the materials) to the Victorian Health Promotion Foundation (VicHealth). VicHealth would like your permission to use the materials in the future for any educational and/or promotional purpose that is consistent with VicHealth’s responsibilities. Please read this form carefully before making a submission.

By submitting your photograph or video footage and ticking the checkbox next to “I agree to this video being used in promotional materials in line with the VicHealth Privacy Policy”, you agree to the following:

I am the owner of the copyright in the materials under the Copyright Act 1968 (Cth) and warrant to VicHealth that this is the case and that I have obtained any permissions necessary in order to grant the licence to VicHealth in accordance with this form;

OR

I am not the owner of the copyright in the materials under the Copyright Act 1968 (Cth) and warrant to VicHealth that I have permission from the copyright owner and have obtained any other permission necessary to grant the licence to VicHealth in accordance with this form.

I grant to VicHealth a non-exclusive, worldwide perpetual, transferable licence (including the right to sublicense) to use, reproduce, adapt, modify, publish, distribute and communicate the materials in a range of online and printed formats including but not limited to printed publications, television or print advertising, online publications and on websites, YouTube, Facebook, Twitter, blogs, microblogs and any other media (including social media) for any educational and/or promotional purpose that is consistent with the responsibilities of VicHealth.

Where I am the author or maker of the photographs and/or footage, I acknowledge and agree that in respect of such use it is reasonable not to identify me as the author or maker of the work.

I understand that VicHealth cannot control or be held responsible for any adverse or defamatory use of this footage and/or these photographs by third parties, once they have been published online or in printed format.

I understand that I will not receive any compensation of remuneration from VicHealth arising out of the use of the materials.

 

Privacy Consent

To the extent that my personal information appears in the materials, I consent to VicHealth using the materials for any educational and/or promotional purpose that is consistent with the responsibilities of VicHealth.

I understand that VicHealth will comply with the Information Privacy Act 2000 (Vic) in connection with my personal information.

 

Withdrawal of Privacy Consent

Please note that you are entitled at any time to withdraw your consent to the above uses of your personal information by contacting VicHealth’s Campaigns Team by telephone at (03) 9667 1366 or in writing to PO Box 154, Carlton South, VIC 3053.

If you do withdraw your consent, VicHealth will discontinue any further use of the image and/or video footage and will use its best endeavours to remove such image and/or video footage from its online publications.

You acknowledge that VicHealth’s ability to remove your image and/or video footage from the internet is limited where such materials have been published by third parties.

 

Authorisation

I represent and warrant that I am at least 18 years of age and have read and understood this form.

I consent to VicHealth using the materials for any educational and/or promotional purpose that is consistent with the responsibilities of VicHealth.

I grant VicHealth copyright licence to my photograph(s) and/or video footage.

I have read and understood the Video and Photo Consent form with Copyright Licence.