INTERNAL MEDIA CONSENT FORM

Note to Participant : Safehaven – a Ray of Hope would like to collect information from you about your story and experiences with Safehaven – a Ray of Hope. We use the information that you provide to promote the work of Safehaven – a Ray of Hope.
We will only pass your information on to third parties with your consent or where we are required to do so by law. You can also write to us if you would like to see any information which we hold about you. We will provide this information in line with the Data Protection Act 1998.

Safehaven – a Ray of Hope may wish to tell your story and/or use your photograph in the circumstances set out below. Please can you indicate whether you would like us to do this or not, by circling the appropriate response below:

Internal media consent form

May Safehaven – a Ray of Hope tell your story, video and/or photograph in our published materials (for example, in a leaflet to promote Safehaven – a Ray of Hope), or on our website?
May Safehaven – a Ray of Hope pass your story, video and/or photograph on to the media (for example your local newspaper or TV station)? If used by the media, we would contact you to let you know when and where your story will appear.
May Safehaven – a Ray of Hope pass your story, video and/or photograph on to our funders to use as good news stories when speaking publicly or in the House and for promoting services available
I understand my right to ask to see any information held about me by Safehaven – a Ray of Hope.
Participant’s Name
Participant's Name

Internal media consent form