School of Education.

Permission Form

As a preservice teacher at CDU, I am requesting your permission, to be able to use your photograph,
image, words, artwork or video/audio recording (the talent).
Wherever possible, the preservice teacher at Charles Darwin University/ will be understanding of
cultural, family and personal sensitivities.
By signing and returning this form you have granted the preservice teacher from Charles Darwin
University and The school of Education unrestricted right to use, reproduce and publish:

the photographs taken, including image and likeness as depicted therein

written works
the artwork
the video/audio recording

Thank you for your consideration to this matter.

Preservice Teacher
Name:
If under 18 signature of parent/guardian
Student Name: :
Parent/guardian name:..
Contact details parent/guardian - Ph.: .Email:

Signature of parent/guardian:. Date: