Parent or guardian photo consent

Thank you for helping us by allowing your name and image to be used in future communication materials. If you have any questions or reservations after signing this consent form please do not hesitate to contact us.

Parent/guardian's details

Title

Please check this value

First name

This field is required.

Last name

This field is required.

Email address

This field is required.

Phone number

This field is required.

Children's details

Enter up to three children's details:

Child 1 first name

This field is required.

Child 1 last name

This field is required.

Child 1 date of birth

Please add a date in this format DD/MM/YYYY

Child 2 first name

Please check this value

Child 2 last name

Please check this value

Child 2 date of birth

Please add a date in this format DD/MM/YYYY

Child 3 first name

Please check this value

Child 3 last name

Please check this value

Child 3 date of birth

Please add a date in this format DD/MM/YYYY

How we might use your image in the future

The Royal Marsden* may use your images after the initial consent form has been signed in different communication materials, for example corporate reports, brochures and presentations. This also includes patient information literature, posters and exhibition displays, our website, or in communication material such as adverts in trade or consumer press or online (this is not exhaustive).

Images/film footage may be used by external companies, commissioned or employed by The Royal Marsden, for the production or publication of materials, on behalf of The Royal Marsden.

Your consent

By checking the box below, you are consenting to the following:

I authorise The Royal Marsden to use my name and image in all communications (including publicity materials).
I understand that I/my child will be identifiable and could be named in relation to the image and the image will be used without any further discussion unless I withdraw consent in writing to the Marketing and Communications Team, at the address below.
I consent to my image and contact details as listed above to be stored for future use and contact.
I understand that if my consent is withdrawn, The Royal Marsden will use its reasonable endeavours to destroy or delete any identifiable images of me/my child.
I have read this form carefully and understand its meanings and implications.

I acknowledge that by checking this box, I give The Royal Marsden full copyright and authority to publish the photographs and agree with the terms listed above.

This field is required.

*The Royal Marsden includes The Royal Marsden NHS Foundation Trust, The Royal Marsden Cancer Charity, The Royal Marsden Private Care, The Royal Marsden School and The Royal Marsden Community Services.

Please send all enquiries to:

Community Fundraising Team
The Royal Marsden Cancer Charity
Downs Road
Sutton
Surrey
SM2 5PT
Email: community.fundraising@rmh.nhs.uk
Tel: 020 8661 3391

Thank you for submitting your consent form.

If you have any questions, please contact the Community Fundraising Team at community.fundraising@rmh.nhs.uk

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