Consent form releasing materials for Council use

Important privacy information

Brisbane City Council (Council) requires consent to use the Material for the purposes of promoting various Council programs, services and initiatives.   Your consent to the use of the Material is required in accordance with the Information Privacy Act 2009.  The information privacy principles contained in that Act govern the collection, use, storage, security, and disclosure of personal information. The Material will be stored on a Council database.  Only authorised Council officers will have access to it.  From time to time Council may provide some or all of the Material to its subsidiary corporations and entities, contracted Council suppliers or to media organisations to promote various Council programs, services and initiatives. Your personal information contained in this form will not be disclosed to any other third party without your consent, unless authorised or required by law.

If you have any queries about any privacy issues that relate to this consent form then please contact Council’s Information and Privacy officer.

Who is a child? A child is a son, daughter, including any step-child or adopted child or any other dependent under the age of 18 years.

Who is a person with a decision-making disability? A person with a decision-making disability is a person who cannot give consent because they lack capacity or have an intellectual or other impairment that affects their capacity to give consent.  If a person is an adult and is unable to give consent, an authorised decision-maker must give consent on the person’s behalf (for example under the Powers of Attorney Act 1998 and/or the Guardianship and Administration Act 2000).

What happens to the consent form once it is filled out?  This consent form will be retained by Council.  A copy may be provided to the Participant upon written request.

Modification or withdrawal of consent Consent can be modified or withdrawn in writing at any time.  Any changes to, or withdrawal of, your consent will only apply from the date that the request is received by Council.  If the Material is being used in existing Council advertising materials or other Council products, those advertising materials or other Council products will not be withdrawn from use.

Other considerations. If Council is notified that a participant has passed away their image and consent will be withdrawn immediately.

All fields are mandatory unless otherwise advised.

Information collected in this form will be handled in accordance with Council's Privacy Policy.

Preferred contact method: *
Mobile or land line (include area code for land lines)
So that your image is used in the appropriate context, do you identify as Aboriginal and/or Torres Strait Islander? (optional)
Electronic signature *
20 November 2017