Back to Back Theatre

60 Little Malop St
Australia 3220

Postal Address

PO Box 1257
Australia 3220

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ABN 95 834 484 241

RADIAL | Melbourne Fringe Festival

Thanks for participating in RADIAL. Please fill out the form below to register your permission to appear in film.

I give my permission to be filmed as part of Back to Back Theatre’s residency project RADIAL, created with Melbourne Fringe Festival.

I grant Back to Back Theatre and Melbourne Fringe Festival the right to use my footage from RADIAL for non-commercial purposes. This includes using my footage as part of the final film that may be used for promotional purposes in a variety of media and online.

I grant Back to Back Theatre permission to utilise the work I produce with them as Back to Back Theatre deems appropriate within the context of the overall film. I understand this may alter from any preconceptions I have or from conversations held with the RADIAL team.

I provide permission for Back to Back Theatre to use any music I provide as part RADIAL on a Royalty free basis. I also confirm by signing this form that the music I have provided is copyright free.

I grant Back to Back Theatre permission to include my name (as written below) in the film credits.

By signing below I indicate that I understood and agree to the above

RADIAL Participant Permission Form

  • Choose one.
  • Please print carefully so we can get your film credit right.
  • MM slash DD slash YYYY


Melbourne Fringe Festival and Back to Back Theatre will respect your right to information privacy. Information we collect and hold is kept in accordance with Information Privacy Laws.  We will use our best endeavours to keep the information accurate, up to date and securely handled, and protect the information from misuse and unauthorised access.

For more information about what we do with the data you give us please see our privacy policy or contact