Consent Form - Burnley Leisure & Culture

To be completed by child (under 16 yrs or vulnerable adult):

I give permission for my photograph and/or to be used within Burnley Leisure and Culture for display purposes
I give permission for my photograph and/or to be used within other printed publications
I give permission for my photograph and/or to be used on the Burnley Leisure and Culture website
I give permission for videos of me to be used on the Burnley Leisure and Culture website
I give permission for my photograph and/or to be used on the Burnley Leisure and Culture social media pages
I give permission for videos of me to be used on the Burnley Leisure and Culture social media pages

Signature of child (under 16 yrs or vulnerable adult):

Clear Signature

Name of child (under 16 yrs or vulnerable adult):

If the child is under 16, consent must be obtained from a parent, guardian or carer. If over 16, it’s still good practice to inform parents that photographs/videos of their child may be used if the child has given consent.

To be completed by parent, guardian or carer:

I give permission for my child’s photograph and/or quote to be used within Burnley Leisure and Culture for display purposes
I give permission for my child’s photograph and/or quote to be used within other printed publications
I give permission for my child’s photograph and/or quote to be used on Burnley Leisure and Culture website
I give permission for my child to be videoed for use on the Burnley Leisure and Culture website
I give permission for my child’s photograph and/or quote to be used on the Burnley Leisure and Culture social media pages
I give permission for my child to be videoed for use on the Burnley Leisure and Culture social media pages
I can confirm that I have read, or been made aware of how these images or videos will be stored within the organisation.

Signature of parent, guardian or carer:

Clear Signature

Name of parent, guardian or carer:

Email

(under completed (under

Consent form requested by *

If known, which BLC Department is this for?

Leave blank if unknown.

Over 16 Consent Form

Under 16 or Vulnerable Adult Consent Form