Geckos Inc. - German Community School Melbourne
5A Carrington Rd, Reservoir, VIC 3073 (Reservoir West Primary School)
Teachers and Staff
Projects & Sponsors
Geckos German Community School is seeking your permission to use media (photo, video, audio) and your child"s work samples (e.g. drawings, written words, paintings) in which you or your child/children appear for teaching, learning and promotional purposes.
By completing this section you are give your consent to the German Community School of Melbourne;
I, the undersigned person, give consent to Geckos German Community School to make use and/or retain photos, videos, audio or any other form of electronic recordings that may identify me, my child or an individual for whom I have authorized decision-making responsibility.
I also give consent to Geckos German Community School to make use and/or retain my child"s work samples.
Consent may be withdrawn or modified at any time in writing to the secretary of Geckos German Community School
by email to firstname.lastname@example.org
by mail to The Secretary, Geckos German Community School, The Pavilion, Sylvester Grove, Preston VIC 3072
If you have any restrictions you want to apply to the use of your personal information, please list below (e.g. cultural considerations, usage restrictions, expiry of consent, etc):
Media/child"s work samples can only be used in print (e.g. newsletters)
Media/child"s work samples can only be used for online purposes (e.g. web page, facebook)
Media/child"s work samples can be used in print AND online
If there are other restrictions, please list them here:
I understand that by giving consent, the Geckos German Community School can use the image/s to promote their purpose.
Geckos German Community School may reproduce the image/s in any form, in whole or in part, and distribute the works by any medium including the Internet, CD-ROM or other multimedia.
I understand that Geckos German Community School:
will not pay me for giving this consent or for the use of my image/s;
may keep the image/s on record until I revoke my consent;
will return or destroy images if I withdraw this consent, with the exception of those already published;
may use the image in the future, unless I specify limitations for its use;
will not infringe the rights of any third party by exercising its rights given in this consent.
Please print this page, sign, and return to Geckos Community German School
Geckos Melbourne Inc (2014)