Family media permission form - for a parent or carer and their children "*" indicates required fields Your name for your own personal consent* The names and dates of birth of the children and young people you are also providing consent for (we have a separate form for those aged 13 to 17 who have the capacity to provide their own consent).*I have parental responsibility for the children and young people listed above.* Yes No I provide consent for any photos, films and audio taken at EACH events (inc. by organisations supporting/attending our events) to be used at the discretion of the EACH Marketing and Communications team, including in printed materials, the media and online. I understand this may mean content will be in the public domain for several years and could appear without my specific knowledge of the publication or article. This could include time beyond receiving EACH services.* Yes No I am happy for names to be published alongside* Yes No I am happy for group images and footage to be shared with other families* Yes No I am happy for consent to apply from this date forward* until I notify you otherwise.* Yes No Please select the hospice you are associated with Milton The Nook The Treehouse *Date form completed* Email address* To find out more on how we use your information A note about social media: We understand the importance of social media but kindly ask that no staff names are mentioned in any posts you may do. YOUR PRIVACY Your information is held securely with all reasonable precautions used to protect it. We will only allow your information to be used by suppliers working on our behalf and will only share it elsewhere if required to do so by law. For full details, please see our privacy policy. CAPTCHA
