Common use of LIMITATION OF CONSENT Clause in Contracts

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenter........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenterconsenter ........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: ➏ CONSENT AND AGREEMENT ▶ ⮚ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ............................................................................................................................... Print name of consenterconsenter ........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. Date ................................................... Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ................................................................................................................................ Print name of consenter........................................................................................................................... ………………………………………………………………………………………………. Signature or mark of consenter ................................................................................................................ consenter……………… .................................................................................................. Date ................................................... .......................................................... Signature or mark of student (if applicable) .............................................................................................. Date .............................................................................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ............................................................................................................................... Print name of consenter........................................................................................................................... consenter .............................................................................................................................. Signature or mark of consenter ................................................................................................................ consenter................................................................................................................... Date ................................................... ..................................................... Signature or mark of student (if applicable) .............................................................................................. ................................................................................................ Date ........................................................................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ........................................................................................................................... Print name of consenter........................................................................................................................... consenter . ....................................................................................................................... Signature or mark of consenter ................................................................................................................ ................................................................. Date ................................................... ................................ Signature or mark of student (if applicable) .............................................................................................. Date ...................................................)…………………………………………………………………....

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. I agree to use the Prep Portfolio and the Farewell Album for my personal use only and agree not copy, publish, edit, adapt, distribute, make available online or electronically transmit the Prep Portfolio or the Farewell Album without obtaining prior written permission from the school. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ student: ............................................................................................................................... Print name of consenter: ........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date consenter.................................................................................................................. Date: ................................................... Signature or mark of student (if applicable) ): .............................................................................................. Date Date: ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: Uncontrolled copy. Refer to the Department of Education Policy and Procedure Register at xxxx://xxx.xxx.xxx.xxx.xx/ to ensure you have the most current version of this document. Page 3 of 4 CONSENT AND AGREEMENT ▶  CONSENTER – I am (tick the applicable box): ⬜  parent/carer of the identified person in section 1 ⬜  the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜  recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenter........................................................................................................................... Signature or mark of consenter consenter................................................................................................................ Date ................................................... Signature or mark of student (if applicable) ).............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶  CONSENTER – I am (tick the applicable box): ⬜ CONSENT AND AGREEMENT  parent/carer of the identified person in section 1 ⬜  the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜  recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ .................................................................................................................. Print name of consenter........................................................................................................................... consenter ............................................................................................................... Signature or mark xxxx of consenter ................................................................................................................ .................................................................................................... Date ................................................... ......................................... Signature or mark xxxx of student (if applicable) .............................................................................................. .................................................................................. Date ............................................................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ Stanthorpe State High School 13  CONSENTER – I am (tick the applicable box): ⬜  parent/carer of the identified person in section 1 ⬜  the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜  recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenter........................................................................................................................... Signature or mark of consenter consenter................................................................................................................ Date ................................................... Signature or mark of student (if applicable) ).............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual individual and/or parent wishes wished to limit consent in the following way:  CONSENT AND AGREEMENT ▶  CONSENTER – I am (tick the applicable box): ⬜  parent/carer of the identified person in section 1 ⬜  the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜  recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed details in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2section2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third third-party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ……………………………………………………….…………………………………………………. Print name of consenter........................................................................................................................... consenter ………………………………………………………………………………………………………. Signature or mark of consenter ................................................................................................................ ……………………………………………………………………………….……… Date ................................................... …………………………………… Signature or mark of student (if applicable) .............................................................................................. ……………………………………………………………….…… Date ...................................................…………………………………… SPECIAL CIRCUMSTANCES - If the form is required to be read out (whether in English or in an alternative language or dialect) to a parent/carer or Individual student; or when the consenter is an independent student and under 18 the section below must be completed.  WITNESS – for consent from an independent student or where the explanatory letter and State School Consent Form were read I have witnessed the signature of an independent student, or the accurate reading of the explanatory letter and the State School Consent Form was completed in accordance with the instruction of the potential consenter. The individual has had the opportunity to ask questions. I confirm that the individual has given consent freely and I understand the person understood the implications; Print name of witness ……………………………………………………………………….………………….. Signature of witness ……………………………………………………………………………………….…….. Date ………………………………………………..  Statement by the person taking consent – when it is read I have accurately read out the explanatory letter and State School Consent Form to the potential consenter, and to the best of my ability made sure that the person understands that the following will be done:

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenter........................................................................................................................... Signature or mark of consenter consenter................................................................................................................ Date ................................................... Signature or mark of student (if applicable) ).............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ ⬜ ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenterconsenter ........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual individual and/or parent wishes wished to limit consent in the following way: ➏ CONSENT AND AGREEMENT ▶ ⏵ CONSENTER – I am (tick the applicable box): ⬜ 🞏 parent/carer of the identified person in section 1 ⬜ 🞏 the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ 🞏 recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed details in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2section2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third third-party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ……………………………………………………….…………………………………………………. Print name of consenter........................................................................................................................... consenter ………………………………………………………………………………………………………. Signature or mark of consenter ................................................................................................................ ……………………………………………………………………………….……… Date ................................................... …………………………………… Signature or mark of student (if applicable) .............................................................................................. ……………………………………………………………….…… Date ...................................................…………………………………… SPECIAL CIRCUMSTANCES - If the form is required to be read out (whether in English or in an alternative language or dialect) to a parent/carer or Individual student; or when the consenter is an independent student and under 18 the section below must be completed. ⏵ WITNESS – for consent from an independent student or where the explanatory letter and State School Consent Form were read I have witnessed the signature of an independent student, or the accurate reading of the explanatory letter and the State School Consent Form was completed in accordance with the instruction of the potential consenter. The individual has had the opportunity to ask questions. I confirm that the individual has given consent freely and I understand the person understood the implications; Print name of witness ……………………………………………………………………….………………….. Signature of witness ……………………………………………………………………………………….…….. Date ……………………………………………….. ⏵ Statement by the person taking consent – when it is read I have accurately read out the explanatory letter and State School Consent Form to the potential consenter, and to the best of my ability made sure that the person understands that the following will be done:

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ ⬜ ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any andany questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third third-party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenter........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date ................................................... Signature or mark of student (if applicable) ).............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶  CONSENTER – I am (tick the applicable box): ⬜ CONSENT AND AGREEMENT  parent/carer of the identified person in section 1 ⬜  the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜  recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ................................................................................................................. Print name of consenter........................................................................................................................... consenter .............................................................................................................. Signature or mark xxxx of consenter ................................................................................................................ ................................................................................................... Date ................................................... ............................................ Signature or mark xxxx of student (if applicable) .............................................................................................. ................................................................................. Date ...............................................................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ ⬜ ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenter........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ........................................................................................................................... Print name of consenter........................................................................................................................... . ....................................................................................................................... Signature or mark of consenter ................................................................................................................ ............................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. .......................................................................................... Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): CONSENT AND AGREEMENT ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ................................................................................................................. Print name of consenter........................................................................................................................... consenter .............................................................................................................. Signature or mark of consenter ................................................................................................................ ................................................................................................... Date ................................................... ............................................ Signature or mark of student (if applicable) .............................................................................................. ................................................................................. Date ...............................................................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: Page 12 of Online Services consent form CONSENT AND AGREEMENT ▶ 🠺 CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenter........................................................................................................................... Signature or mark of consenter consenter................................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: Uncontrolled copy. Refer to the Department of Education Policy and Procedure Register at xxxx://xxx.xxx.xxx.xxx.xx/ to ensure you have the most current version of this document. Page 3 of 4 CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ Print name of consenterconsenter ........................................................................................................................... Signature or mark of consenter ................................................................................................................ Date ................................................... Signature or mark of student (if applicable) .............................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ................................................................................................................... Print name of consenter........................................................................................................................... ................................................................................................................. Signature or mark of consenter ................................................................................................................ Date ................................................... consenter..................................................................................Date: ………………............... Signature or mark of student (if applicable) .............................................................................................. Date ...................................................applicable)................................................................Date......................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ............................................................................................................. Print name of consenter........................................................................................................................... ............................................................................................................ Signature or mark of consenter ................................................................................................................ consenter.................................................................................................. Date ................................................... Signature or mark of student (if applicable) .............................................................................................. ).................................................................................. Date ...................................................

LIMITATION OF CONSENT. The Individual and/or parent wishes to limit consent in the following way: CONSENT AND AGREEMENT ▶ CONSENTER – I am (tick the applicable box): ⬜ parent/carer of the identified person in section 1 ⬜ the identified person in section 1 (if a mature/independent student or employee including volunteers) ⬜ recognised representative for the Indigenous knowledge or culture expressed by the materials I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the purposes detailed in section 3. By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials (detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the licensed materials may not be reproduced in their entirety. Print name of student ............................................................................................................................ ............................................................................................................................... Print name of consenter........................................................................................................................... .............................................................................................................................. Signature or mark of consenter ................................................................................................................ consenter................................................................................................................... Date ................................................... ..................................................... Signature or mark of student (if applicable) .............................................................................................. ................................................................................................ Date ........................................................................................................