Media Consent Form A ‑ Recordings made by Dalhousie University

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 I understand and consent

                                                                                                         

A. Personal Information (This information will be used solely for internal administrative purposes, and for contacting you in the future in the event that further notification and/or consents are necessary.)

 
 
 Faculty
 Staff
 Student
 Other
 
 
 
 

 

B. Recording Details (Please be as specific as possible.)

 
 
 Photograph
 Video
 Audio
 Other

 

C. Permitted Uses (I consent to the following uses, except where limited in section D.)
• Administrative: Made available or used within Dalhousie. Example uses: ID cards, printed directories or handbooks, intranets or private websites.
• Publications: Made available or used externally on a not-for-profit basis. Example uses: marketing and promotional material (brochures, DVDs, videos, websites), annual reports, media releases, magazine articles.
• Internal Education: Made available or used for educational purposes (including lectures, workshops, tutorials, lab or clinical skills demonstrations, grand round presentations) within Dalhousie. Example uses: tutorial case exhibits, lecture handouts, DVDs or videotapes on library reserve, internal media or learning objective libraries.
• External Education: Made available or used for educational purposes external to Dalhousie on a not-for-profit basis. Example uses: external media or learning object libraries, journal articles, international projects.

D. Other limitations on Use (Please list other limitations, such as time limits on use, in detail below)

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