Story consent form

Your story is helping us to show the impact that Perennial is making to people’s lives; thank you for your support.

How will your case study be used?

In Perennial marketing materials (e.g. a leaflet, magazine, presentation or email newsletter to promote Perennial).
On Perennial’s website or social media sites.
In the media (e.g. to promote Perennial in a magazine or newspaper).
In our printed or online advertising.
By other organisations that want to promote Perennial’s work by including in their own newsletters and internal communications, for example trade association or companies.
It is not possible to closely control where stories are shared as social media and electronic devices allow content to be distributed.
It will be used for up to three years unless you ask us to stop using it.

I understand that:

Information about me will be held in accordance with Perennial’s Privacy Policy and in accordance with the Data Protection Act 2018 and the UK General Data Protection Regulation (GDPR).
While Perennial makes every effort to ensure all media coverage is positive, the charity does not have final control over how a journalist may portray me.
Perennial will only pass your information on to third parties with your consent or where we are required to do so by law.
You can 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 2018 and UK GDPR.
I can request that Perennial stop using my story at any time, in which case it will not be used in future publications or on the website, but it may continue to appear in print and digital publications already in circulation / the public domain. To request this please email marketing@perennial.org.uk or call 01372 373692.

Story Reference Number

Unique identifier which can be found on your story

I accept these terms and give consent for Perennial to use my story as follows*

Yes (full name)Yes (first name only)Yes (anonymous)No

I confirm that any other individuals named as part of the story give their consent*

Yes (full name)Yes (first name only)Yes (anonymous)N/A

Name*

TitleFirst nameLast name

Organisation (if applicable)

Address*

Address line 1

Address line 2

City/TownCounty

Postcode

Phone number*

Email address*

Age confirmation*

I am over 18 years of age

We would love to keep you posted with news updates from Perennial, including ways we can support you and your family. Your details will be used by Perennial in accordance with our Privacy Policy. If you already receive marketing communications from us, this will be unaffected by a box being left blank on this form.

Please tell us if you are happy for us to contact you with updates:

By emailBy post

Service User Story Consent Form v1.0 last updated 28/03/2024