Sussex Community NHS Charity Photo Permission Form
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1. Name of person in photos or film *
2. Are you over 18-years old?
Please note that if you are under 18 we will need your parent/guardian to complete the following form on your behalf: https://www.smartsurvey.co.uk/s/under18scharitymediaconsent/
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3. Contact details (telephone and/or email) *
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4. I give consent for photographs and/or video recordings of me to be taken and/or used for the purpose of promoting the principles and practices of Sussex Community NHS Charity.
I understand that all or part of the photograph or video recording may be used with other forms of illustration and text in publications (such as leaflets and posters), journals, textbooks, advertising, websites and any other public media for distribution. I understand the image may be altered and I waive the right to approve any finished product.
I understand that any photograph/video recording of me will be held securely on our computer system.
I understand that I will not be paid for allowing the photographs or video recording to be taken and used.
I understand that although I may withdraw my consent at any time, not all future use can be stopped.
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5. I agree that my name and identity may be revealed in descriptive text or commentary in connection with the image(s) or recording(s). *
6. If there is any specific purpose that you DO NOT wish for your images/film to be used, please advise:
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8. Signature (electronic): *
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The answer is in an invalid format.
9. Please enter today's date: *