Online Form - CKB Model Release Form

I hereby give the City of Kalgoorlie-Boulder and assign my permission for the following:

  • The model (or guardian) hereby assigns to the City of Kalgoorlie-Boulder the right to use and publish photography, video, and/or audio content of the model in any and all forms of media for non-commercial purposes in relation to City of Kalgoorlie-Boulder's advertising, marketing and initiatives. 
  • The content may be combined with other images, text, graphics, film, audio-visual works; and may be cropped, altered or modified as per sole discretion of the City of Kalgoorlie-Boulder.
  • The model has no rights to the content, but may be given access to the content that contains their image or audio (upon request) after the City of Kalgoorlie-Boulder has made said content public
  • My personal information will not be made publicly available but may only be used directly in relation to licensing of the content where necessary (e.g. to defend claims, protect rights or notify trade unions) and may be retained as long as necessary to fulfill this purpose. 
By ticking the box below, you hereby give the City of Kalgoorlie-Boulder permission to use your photo and agree to the information above. The information you provide will be processed in accordance with our Privacy Policy which can be found on our website.*