Participant Media Consent Form

Participant First Name:

Participant Last Name:

COVEY regularly seeks opportunities to promote its work and showcase the positive impact its services have on children, young people and families. In order to do this effectively, COVEY uses photographs, videos and quotes from our participants and staff.

In accordance with the General Data Protection Regulation (GDPR) and our policy, COVEY will not permit photographs, videos or quotes to be taken or recorded without consent. Participants aged 16 and over can fill in this consent form on their own behalf. However, if the participant is under 16, this must be completed by a parent/carer.

COVEY will take all steps to ensure these images, videos and quotes are used solely for the purposes for which they are intended. The consent granted on this form can be retracted at any time by sending an email to office@coveybefriending.org.uk or calling our office on 01698 894013.

Declaration of Consent

Please read the information on external public sharing and internal anonymised/non anonymised sharing below. Then select Yes or No from the options underneath each.

1. External Public Sharing

I give permission for COVEY to use recorded quotes, videos and photographs of me. I understand that I will be identifiable in these. I understand this information may be used in printed/online publications, presentations and promotional releases, including those outlined below. I understand that I can retract this consent at any time by contacting COVEY using the provided details and that use of my photographs/videos/recorded quotes will cease.

• Leaflets, giving information about our services and opportunities.

• Newsletters, updating our community about latest news and upcoming events/opportunities.

• Case Studies in funder/board reports, detailing the impact of our services.

• Social media platforms, promoting our services, opportunities, and latest news updates.

• Press releases, giving information to local press about our services, opportunities and impact.

• Website, giving information on our services and latest news updates

Your Declaration:

Your Declaration (by phone):

2. Internal Anonymised Sharing

I give permission for COVEY to use recorded quotes and information to create anonymised case studies for use in reports (such as funding bids, board reports and project evaluations) to detail the impact of our services. I understand that I will not be identifiable in these.

Your Declaration:

Your Declaration (by phone):

3. Internal Non - Anonymised Sharing

I give permission for COVEY to use recorded quotes, information, videos and photographs to create case studies for internal reports to funders and service partners (such as funding bids, board reports and project evaluations) to detail the impact of our services. I understand that I will be identifiable in these.

Your Declaration (by phone):

Your Declaration:

I am:

Participant Signature (if signing on behalf of themself):

Parent/Carer Name (if signing on behalf of their child/young person):

Parent/Carer Signature (if signing on behalf of their child/young person):

COVEY Staff Member Name:

COVEY Staff Member Name obtaining consent by phone:

COVEY Staff Member Signature:

COVEY Staff Member Signature who is obtaining consent by phone:

Date of Declaration:

Date