Photography, Videography & Case Study Consent Form Your name Please enter a description of the event, fundraiser or activity the photos/video/case study relates to: Name or position of the staff member organising the photos/video/case study: (if applicable) Please tick if you're happy for us to publish your: Photographs Video Quotes and case studies I give my consent for this material to appear online & in printed format in perpetuity, which may include but is not limited to the hospice’s website & social media sites, the hospice newsletter, annual review and other printed literature, local & national newspapers, other publications, and promotional activity. Date Signature Submit