Release form – adults
This form records that you give permission to Victoria Legal Aid and community legal centres delivering Sex, young people and the law
(SYPL) sessions to photograph, film or record you in a SYPL session.
This form also explains what we may do with your image.
Your details: ........................................................................................................................................
Full name: ............................................................................................................................................
Contact telephone number (optional): ..............................................................................................
Postal address (optional): ..................................................................................................................
Email (optional): ..................................................................................................................................
We are asking for this information so we know which images are of you and can contact you with questions if we need. We will not use it
for anything else.
Your agreement
I agree to the terms and understand the conditions set out on the next page. I confirm that I am old enough to understand and consent to
the contents of this form.
Name: ..................................................................................................................................................
Signature: ............................................................................................................................................
Date: ....................................................................................................................................................
Conditions for using photographs and video recordings
By signing this form you agree:

Victoria Legal Aid or the community legal centre may collect your name and contact details on this form. We may also collect your
image by taking photos and image (photo or video recording) at the SYPL session

Victoria Legal Aid or the community legal centre may use your image in promotional and information materials for Victoria Legal
Aid or the community legal centre, such as pamphlets, brochures, stories and reports. This may include information published on
the internet.

Victoria Legal Aid or the community legal centre will use your image by you granting us a ‘non-exclusive licence’. This means
Victoria Legal Aid or the community legal centre can use your image without acknowledging you or paying you now or in the
future.
Some important things to know:

You can withdraw this consent at any time by contacting Victoria Legal Aid on [email protected] or 9269 0223 or the community
legal centre on xxxx

If you withdraw your permission we will destroy your image and not use it in any new publications created after that date. You can
also contact on [email protected] or 9269 0223 or the community legal centre on xxxx if you have any questions about this form.

We will not use your photo or recording in a manner that may be deemed adverse or defamatory to you. Victoria Legal Aid or the
community legal centre will not use your image for political gain or to make any money.

We will handle you and your child’s information in accordance with the Information Privacy Act (Vic) 2000 and the Public Records
Act 1973. This means we will keep you and your child’s information secure, handle it with regard to your privacy and destroy it
after an certain period of time.
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