Story and Photo Consent Form - Surrey Coalition of Disabled People

Please complete this form to tell us about how we can use your photo(s) and story to help publicise our work as part of our feedback about services you have used to commissioners

Story & Photo consent form

Photo consent form

First Name(Required)

Surname(Required)

Telephone Number(Required)

Email Address(Required)

I give Surrey Coalition of Disabled People permission to use my photo(s) in any of their communications. This may include email, printed publications (booklets and campaigning materials); electronic materials (e.g. presentations, social media posts and website); and display materials (posters and banners) (You will not be contacted each time your photo is published)(Required)

Yes

I give Surrey Coalition of Disabled People permission to use my story in any of their communications. This may include email, printed publications (booklets and campaigning materials); electronic materials (e.g. presentations, social media posts and website); and display materials (posters and banners) (You will not be contacted each time your story is published)(Required)

Yes

I would like you to use a pseudonym (a made up name) when you use my story, instead of my real name(Required)

Yes

I am happy for Surrey Coalition of Disabled People to contact my story and photos being featured in selected media outlets, for example local news websites, papers etc(Required)

Yes

Data Protection

The information that you give us here will only be used to contact you about your story and your photo(s). We shall not pass the details recorded on this form to any other organisation without your permission. For more information, please refer to our privacy policy on the link below:

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