Media Consent and Release Authority

For definitions and full consent information, please click here. (PDF 157.6KB)

First Name*

Last Name*

Street Address*

Suburb*

State*

Postcode*

Phone Number*

Do you consent to Tamworth Regional Council updating their records with the information provided above?*

Email Address*

Description of person in photo (hair colour, shirt colour etc)*

Event / Project*

Do you wish to identify as:

Aboriginal

Torres Strait Islander

Other

For parents/legal guardians of children or those with authorised substituted decision-making responsibility (if applicable)

I declare that I am the parent/legal guardian of the following child or children or holder of authorised substituted decision-making responsibility for the following person's (collectively "the subjects")

Names, ages and descriptions

Conditions and limitations (tick those, if any, that apply)

I do not allow my name/the subjects' name to be used in association with the images and recordings

Image use is subject to the following cultural considerations

Please specify

Image use is subject to other restrictions

Please specify

By checking this box, I hereby grant to Tamworth Regional Council the irrevocable right to take and use Images and Recordings of me and/or the subjects, for the purposes of Publication for any Council purposes in whole or in part, including but not limited to publication on social media, websites, internet broadcasts and any other publications of any kind as released by Council. I have fully informed myself of the consent, indemnity and release (information above) before checking this box.*

Privacy Statement

Personal information supplied to or collected by Tamworth Regional Council will only be stored and processed by Council for lawful purposes directly related to the functions and activities of Council. Any personal information supplied will only be disclosed to a third party for the purpose of performing a lawful function or activity and for no other purpose. Disclosure of personal information to a third party will be in accordance with Tamworth Regional Council's Privacy Management Plan (PDF 331.7KB).

Mandatory field(s) marked with *