This document sets out how you consent to the trustee for The AR and NJ Trust ABN 90 695 260 533 operating as Foot Balance Technology (Foot Balance Technology, us, we or our) collecting, using and disclosing your personal and sensitive information.
Please review the following and sign your name in the appropriate column depending on whether you do or do not consent. You may also withdraw your consent at any time by informing us. We understand that your needs may change. You can update these consents at any time by providing this completed page to us again or by contacting us.
here. COLLECTION OF YOUR INFORMATION
By signing below, you consent to the collection, use and disclosure of your personal and sensitive information (including to overseas third parties) for the purposes of direct and indirect marketing.
EDUCATION AND TRAINING
By signing below, you consent to the collection, use and disclosure of your personal and sensitive information for the purposes of education and training. This includes Foot Balance Technology using your personal and sensitive information for internal staff education and training, and disclosing this information to third parties (including those overseas) for their own education and training purposes.
By signing below, you consent to the collection, use and disclosure of your personal and sensitive information for the purposes of research development. This includes Foot Balance Technology using your personal and sensitive information for internal research and disclosing this information to third parties (including those overseas) for their own research purposes.
RELEASE OF IMAGES, VIDEOS AND 3D SCANS
By signing below, you consent to Foot Balance Technology making an audio and/or visual recording (including a photograph, video or 3D scan) of any part of your participation in the goods and/or services provided by Foot Balance Technology (Media).
You consent and agree that:
Foot Balance Technology owns all rights (including intellectual property rights) in all Media;
to the extent that you may own any, you assign all present and future copyright or any other intellectual property rights owned by you in the Media to Foot Balance Technology;
Foot Balance Technology may disclose the Media to third parties (including those overseas) for the above purposes; and
Foot Balance Technology may use your name, likeness, voice and biographical material in connection with any use of the Media.
You release and indemnify Foot Balance Technology, its assignees, and licensees from and against any claims arising from any breach of this agreement. You waive any moral rights you may have in the Media and consent to Foot Balance Technology and any of their successors, assignees and licensees, doing all or any acts or omissions which may infringe such moral rights.
AUTHORITY TO CONSENT
By signing below, you represent and warrant that you have the full authority to provide each of the consents in this document because you are the patient or a Representative of the patient.
In this document, “Representative” means:
a parent or legal guardian of a patient (if that patient is under 18 years of age); or
a NDIS nominee, support coordinator, plan manager or representative of the patient.
Signature (or signature of Representative)