Photo & Video Consent Form - Burnley Leisure & Culture

Photo & Video Consent Form

Select centre

First name

Last name

Email

Date / Time

Date

Time

Purpose / Area / Time

Who will appear in the images?

Who name Time

Important Conditions

Images are for the agreed private purpose only and must NOT be shared, posted, uploaded, published or sent to anyone.
No other members, visitors or staff may appear in any image or video unless separate permission has been obtained and approved by centre management.
Check backgrounds, mirrors and reflections. Stop if anyone enters the shot. Staff may ask to check images or stop photography if these rules are not followed.

Declaration

I have read and agree to follow these conditions. I understand that permission is limited to the details above and may be withdrawn by centre staff.
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Signature

Clear Signature

Phone

Staff Approval