AGREEMENT Participant Name: I, ___________________________ (age ______) agree to abide by all of Whitehorse terms and conditions. City Council’s (Parent / Guardian if under 16) Sign: _____________________________ Date: _____________________ PHOTO / IMAGE PERMISSION Participant Name: I, ___________________________ (age ______) give authorisation for my photo / image to be used in any City of Whitehorse or third party printed or online publication for the purpose of promoting or highlighting Council work or activities in perpetuity. (Parent / Guardian if under 16) Sign: _____________________________ Date: _____________________ Please return forms to: Daniel Vincent-Smith Box Hill Activity Centre Manager Tel: 03 9262 6269 Email: daniel.vincent-smith@whitehorse.vic.gov.au Post: Locked Bag 2 Nunawading DC VIC 3131 PRIVACY NOTIFICATION: The information requested on this form is being collected for the purpose of organising the community performance. The information will be used solely by Council for that primary purpose or directly related purpose and will not be disclosed to any other party except as required by law. Should enquiries be received after the initiative regarding your performance, these will be forwarded on to you.
AGREEMENT Participant Name: I, ___________________________ (age ______) agree to abide by all of Whitehorse City Council’s terms and conditions. (Parent / Guardian if under 16) Sign: _____________________________ Date: _____________________ PHOTO / IMAGE PERMISSION Participant Name: I, ___________________________ (age ______) give authorisation for my photo / image to be used in any City of Whitehorse or third party printed or online publication for the purpose of promoting or highlighting Council work or activities in perpetuity. (Parent / Guardian if under 16) Sign: _____________________________ Date: _____________________ Please return forms to: Daniel Vincent-Smith Box Hill Activity Centre Manager Tel: 03 9262 6269 Email: daniel.vincent-smith@whitehorse.vic.gov.au Post: Locked Bag 2 Nunawading DC VIC 3131 PRIVACY NOTIFICATION: The information requested on this form is being collected for the purpose of organising the community performance. The information will be used solely by Council for that primary purpose or directly related purpose and will not be disclosed to any other party except as required by law. Should enquiries be received after the initiative regarding your performance, these will be forwarded on to you.
Pop-up%20Performance%20Expression%20of%20Interest%20Form.docx