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Back to Back Theatre

60 Little Malop St
Geelong
Victoria
Australia 3220

Postal Address

PO Box 1257
Geelong
Victoria
Australia 3220

Tel 61 3 5221 2029
ABN 95 834 484 241

Email →

info@backtobacktheatre.com

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RADIAL PARTICIPANT CONSENT

Great news, your young person has been selected by Hamlyn Views School to participate in a project by Back to Back Theatre called RADIAL.

This is a short film made with the students by a professional film making company. There is no cost, this project is funded by various organisations, including the Department of Education, to connect young people with disabilities into the arts.

Back to Back Theatre is an international theatre company based in Geelong that makes work through the hearts and minds of people with disability, this includes schools, professional actors and community groups. Our Education programs are important to our work. We strongly encourage you to look at this page on our website for a better understanding of the RADIAL project and the work we do.

The RADIAL Filming is taking place on 4th, 5th and 6th April, to proceed we require your consent to film your young person for this project.

I give permission for my young person to be filmed as part of Back to Back Theatre’s residency project RADIAL, created with Hamlyn Views School.

I grant Back to Back Theatre, Hamlyn Views School and approved third parties the right to use my footage from RADIAL for non-commercial purposes. This includes using this footage as part of the final film that may be used for promotional purposes in a variety of media and online platforms.

I grant Back to Back Theatre permission to utilise the work my young person produces in the context of the overall film.

I provide permission for Back to Back Theatre to use any music my young person provides as part of RADIAL on a royalty-free basis.

I grant Back to Back Theatre permission to include their 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

Privacy

Hamlyn Views 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 info@backtobacktheatre.com