Image Consent Form

It's can change your mind at anytime, just complete another consent form to replace the last one.

  • This consent form is relevant for all Clients, their Family and Carers and Bayley House employees.
  • It should be read in conjunction with the Client Rights Documents. In particular the Privacy And Confidentiality Policy
  • Permission and consent may be withdrawn at any time on receipt of a written request or completing this form again.

Bayley House Photography, Video, Audio and Copy Consent

This consent applies to all instances where photographs, film footage, audio material, electronic images, internet (including social media), correspondence and/or quotations are used in material using the Bayley House name or logo or collected/taken in the name of Bayley House or in services or activities organised by Bayley House. Material used will always seek to display the individual and Bayley House in the most positive and appropriate manner.

Name of person appearing in image/video/audio/copy (required)(Required)
DD slash MM slash YYYY

To consent on behalf of a client, you must be a parent, legal guardian or person recognised under Australian law to act on behalf of that individual.

I authorise the use of photographs, video, audio and text/copy (as described above) for or on behalf of the individual named above the following use:

Internal use within Bayley House (eg staff communications):
External use in public facing publications (eg Bayley House website and social media platforms):
If you are completing this form on behalf of someone, your details.(Required)
All the above consent was completed by me and I understand the terms of this consent form

The Small Print

By Signing this consent form I agree to give Bayley House (ABN 79 262 349 071), a company limited by guarantee, its assigns, successors, licensees, legal representatives, employees and agents the irrevocable and enduring right to use my name/photograph/ image/audio recording/video recording and likeness in all forms and manner (“My Image”) for the purposes of advertising, media publicity, publication, general display or for any other promotional purposes in whole or in part, including but not limited to publication on internet web sites, broadcasts and any other publications. I waive any interest that I may have in the copyright to My Image now or at any future time and acknowledge that I am not entitled, nor shall in the future be entitled, to receive any payment or consideration in respect of it and agree to make no claim against Bayley House for any payments for the Publication of My Image. I understand Bayley House cannot control unauthorised use of My Image by persons not associated with Bayley House upon the Publication of My Image. I forever waive any right to inspect or approve any Publication of My Image by Bayley House. I release and indemnify Bayley House from any loss, damage, costs, expense, or claim (including consequential loss) connected with the Publication of My Image, including action for defamation, libellous material, breach of privacy, or copyright.

Please click here to read more about Client Rights

Any questions, feedback or queries about privacy and the way Bayley House manages personal information can be submitted at any time by contacting us here (03) 9982 1500 or email us.