Client Consent Form

Full Name:

Date of Birth

Name of Nominee/Guardian

Phone Number

Email Address

What is the purpose of this form? The purpose of this form is to provide information to you about, and to obtain your consent for the recording of Meet a Musician sessions

I Understand

Why would a Music session be a recorded? Memory Nurture takes the quality of the services we provide seriously. We want to ensure that the programs we provide are of the highest quality. At times we may request to record a session in order to assess the quality of the interactions between the Musician and yourself. It helps us to ensure that the Musicians in the program are meeting your needs and adhering to the guidelines we have set out for them.

I Understand

Will my privacy be protected? This practice is subject to the Privacy Act 1988 and must comply with obligations related to the collection, use and disclosure of personal information, including through Music sessions. The Musician must maintain confidentiality and privacy standards during sessions. You will be informed before a recording takes place and can refuse to be recorded for any reason. While the Musician is obligated to meet standards to protect your privacy and security, telecommunication, including videoconference, may increase exposure to hacking and other online risks; as with all online activities, there is no guarantee of complete privacy and security protection. You may decrease the risk by using a secure internet connection, meeting with the Musician from a private location, and only communicating using secure channels.

I Understand

I agree to have this music session recorded, or to have photographs taken. This material will be sent and stored securely and only used for quality control purposes; and only viewed by the Program Management team as required . I have the right to view the images or video on request. I understand that Memory Nurture utilizes a secure platform however cannot guarantee total protection against hacking or possible tapping into the recording by outsiders.

I Understand and Accept

Client Consent Form

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