Photography consent form

This is a form to record how your image will be used by Southampton Hospitals Charity.

Please complete the form to show that you have read and understood how we will use your image and how it will be recorded and stored under UKGDPR Article 6(1)(a).

All material will remain the property of Southampton Hospitals Charity for a period of six years, after which the images will cease to be used and will be removed from our records unless additional consent is given. If at any time you wish to withdraw your consent, you should contact hello@southamptonhospitalscharity.org.

*Required

Your consent

Southampton Hospitals Charity would like to use your images for the following purposes and as detailed in this form.

In consenting, you understand that you will not be paid for the use of any photographs or interviews and that this material may be re-used within the retention period stated above. You will have no interest in, or claim to, the copyright of any material produced in relation to the use of the images.

Photography consent form

I hereby confirm that I give my full consent to appear in articles and photographs produced for Southampton Hospitals Charity and University Hospital Southampton NHS Foundation Trust. The photographs may be used for brochures and may also be used in other literature and website publicity materials including, but not exclusive of, posters, banners, press releases, social media, and display boards. All material will remain the property of Southampton Hospitals Charity and University Hospital Southampton NHS Foundation Trust for a period of six years, then the images will cease to be used unless given additional consent. If any at time you wish to withdraw your consent, you should contact hello@southamptonhospitalscharity.org. I understand that I will not be paid for the use of any photographs or interviews and that this material may be re-used at any time in the future. I understand that I will have no interest in, or claim to the copyright of any material produced in relation to the project described below.

1. Please confirm that you are happy for your image to be used for promotional materials for Southampton Hospitals Charity (SHC), including in print and digitial brochures and newsletters, website, posters, banners, press releases, display boards, and social media channels.(Required)
2. If you answered NO to the question above, please indicate which channels and publications you WOULD consent to your image being used. (Please tick all that apply)
3. Please state if you give additional consent to print the name of the person featured in the image/film.(Required)
4. Please sign (type name) to confirm that consent is granted. (If under 18, a parent or guardian must complete this form)

Your details

Please fill out your personal details so we have a record of who you are and how we can contact you:
11. Please enter today's date. (Month, Day, Year)(Required)
12. We work closely with University Hospital Southampton and Southampton Children's Hospital to share the same privacy and data retention policies and processes. Would you be happy for your image to be used by UHS and SCH on the channels and platforms you have agreed to as above?(Required)
13. Tick here if you wish to hear about the work Southampton Hospitals Charity does.(Required)

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