Photos,videos and life story consent form

Child's Name *

First Name

Last Name

Name (Parent/Guardian) *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone number *

(###)

###

####

What the story can be used for:

Presentations (for Honeypot's internal and external use)

Website and social media (Honeypot's website and social media channels including Facebook, Twitter, LinkedIn and Instagram)

Publications (Honeypot's leaflets, posters, newsletters and other marketing materials)

Print and online media (national, regional and local papers; magazines and new sites)

Television and radio (national and regional television; national, regional and local radio)

Share with third parties (Sometimes external organisations ask for case study material so they can promote Honeypot’s work through their communication channels (online and offline).

Can I remain anonymous?

You can choose to have your real name published with your story or remain anonymous (where we will use a false name).

I am happy for my/my child's real name to be used

I do not want my/my child's real name to be used

Please complete your name on this form to show you are happy to give permission for the pictures,videos or life story to be used by The Honeypot Children’s Charity for the purposes outlined above. None of the forementioned will be used or stored for any longer than 3 years, unless you ask us to stop using it before then.

First Name

Last Name

Date

MM

DD

YYYY