DIGITISED: COMMUNITIES ONLINE CONTRIBUTOR CONSENT FORM


Title of Project (to be used online) ……………………………………………………………………………

Full legal name of Contributor ……………………………………………………………………………………

Address ………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………

………………………………………………………………………………… Postcode …………………………………

Tel. Day …………………………………………………………… Eve …………………………………………………

Mobile …………………………………………………………………………………………………………………………

Email ……………………………………………………………………………………………………………………………

Date of Birth (where individual) ………………………………

Name of person authorised to sign on behalf of The Contributor (if the Contributor is
an organisation)
………………………………………………………………………………………………………………………………………

Status of Contributor (delete as applicable)

Individual / Partnership / Co. Ltd by Guarantee / Co. Ltd by Shares / Registered Charity

/ Other - please state ………………………………………………………………………………………………………


CONTRIBUTOR’S RESPONSIBILITIES:

To provide multi media materials for digitisation as follows:

Still Images ………………………………………………………………………………………………………………………

Video …………………………………………………………………………………………………………………………………

Sound ………………………………………………………………………………………………………………………………

Text …………………………………………………………………………………………………………………………………

Other - please state …………………………………………………………………………………………………………

These materials will be provided ready for use by Watershed by

………………………… date

Further responsibilities (if applicable)

…………………………………………………………………………………………………………………………………………

CONSENT

The Contributor agrees to provide the above material for digitisation, archiving and publication
online. The Contributor also agrees that material may be used in other formats for publicity
purposes, eg. brochure copy, postcards, screen savers, invitations etc.

The Contributor has read and understood the Intellectual Property Rights Policy. The Contributor
agrees to be bound by the terms of this Consent Form and the IPR policy, and agrees to
reimburse the Watershed for any losses, costs or other liabilities arising out of any failure of the
Contributor to comply with its commitments in this form and the policy.

Watershed’s IPR policy


Signed ……………………………………………………………… Date:…………………………………

For and on behalf of Contributor

(Where the Contributor is a partnership, limited company, charity or other organisation, this form
must by signed by the individual named above, who has authority to do so on behalf of the
Contributor. Where the Contributor is under 18 years of age, this form must by signed by a parent
or guardian.)


Signed ……………………………………………………………… Date:…………………………………

For and on behalf of Watershed Media Centre

Please return completed consent form to:

Ruth Jacobs
Project Manager
Digitised: Communities Online
1 Canon’s Road
Harbourside
Bristol BS1 5TX

Duplicate copies available on request