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


Thanks for participating in THE DEMOCRATIC SET!
Please fill out the form below to register your permission to appear in a film.

I give my permission to Back to Back Theatre (“Theatre”) and Cambridge Junction (“Authority”) and their authorised persons to film me and my performance/work as part of Back to Back Theatre’s residency project THE DEMOCRATIC SET for inclusion in a film (“Film”). I hereby grant the Theatre and the Authority and their authorised persons a permanent, free and unrestricted right to use, reproduce, distribute, adapt and exhibit publicly any recording and film of me and my performance/work for (i) non-commercial purposes and (ii) for promotional purposes in a variety of media, whether offline or online.

If my performance or work consists of any third party’s intellectual property rights (e.g. music), I confirm and ensure that the Theatre, Authority and their authorised persons shall have a free and unrestricted right to utilise such third party’s rights.

I guarantee that my performance and/or my work will not infringe any intellectual property rights or other rights of any other persons.

I acknowledge that the intellectual property rights (including copyright) in the Film or any recordings of me or my performance/work as mentioned above shall belong to the Authority.

I also agree to provide the Authority with personal data for the purposes as set out in the Form and I agree to the privacy policy of the Authority.

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 irrevocably agree to the above


DEM SET Participant Permission Form

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



Cambridge Junction 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