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


Great news, you will be appearing in a project by Back to Back Theatre called RADIAL.

This is a short film made by you in collaboration with a professional film making company. There is no cost, this project is funded by various organisations, to connect people with 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.

I give permission for me/person I am signing for to be filmed as part of Back to Back Theatre’s residency project RADIAL, created with Tantrum.

I grant Back to Back Theatre, Tantrum 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 produced in the context of the overall film.

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

I grant Back to Back Theatre permission to include the 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


Tatrum 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