Multi-Media Release Form: 

Person(s) in video/photograph
 
In consideration of Rural Media and the Project specified on this form, I agree to contribute and participate in the project, the nature and content of which has been fully explained to me, I hereby consent to the filming, photographing and recording of my contribution to and participation in "the project" and the subsequent use of the material by “the project” and the producer/s for publication and promotional purposes, without limitation and in  perpetuity, to include all broadcast media, printed matter and publication to the internet and social media channels.
 

I agree that my contact details may be used for the administration & evaluation of this project in line with Rural Media’s Data Protection Policy.

*For individual contributors under the age of 16 and for whom we have parental / guardian consent surnames will not be used and locations will not be identified in line with our data protection and safeguarding polices.

Equal Opportunities Monitoring

We collect equal opportunities data on those we work with, this information is important in ensuring organisational diversity and will be treated anonymously. Please complete the following questions.

The following questions are regarding your ethnicity.

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please select the appropriate option from the next five selections and continue past any that do not apply without selection.

Thank you for completing this form.