Media and case studies consent form

The way in which we tell the world about Jami, part of Jewish Care and the wonderful work that we do, as well as helping people affected by mental health issues, is by using films, photographs and recordings of people with lived experience or other interest in mental health. We are grateful for your contribution to our work.

Please confirm that you give permission for us to use material/image (film/photograph/case study/artwork/poetry etc) of you/your child/person in your care, in any of the below examples of usage. Photos, films or recordings will only be used in a positive and appropriate context.

"*" indicates required fields

The child in your care or your personal details*

Upload image of person to help us match this form to the content captured

Accepted file types: jpg, jpeg, png, gif.

Age if under 18

Address*

Phone*

Email*

I give my permission for the following uses:
I understand that my image/recording/material (e.g. case study/personal story) will become part of Jami, part of Jewish Care’s library and may be used in/on:
• Printed publications
• Website/electronic documents
• Appeals / fundraising
• Direct mail campaigns
• Press relations
• Magazines
• Advertisements
• Social media
• Websites/social media channels/publications of third parties that work in collaboration with Jami/Jewish Care

My consent and understanding:

I consent to Jami, part of Jewish Care, taking pictures, videos, case studies, audios that include me and using them for the purposes explained in this form.*

Yes

I understand that I have no copyright or ownership of the photograph(s)/film(s)/ recording(s).*

Yes

I understand that I can ask for my consent to be removed at any time and that the use of my photos and other information authorised by this form will immediately stop. To do this, I will email info@jamiuk.org or inform a member of staff.*

Yes

I understand that if I ask for my consent to be removed, Jami, part of Jewish Care, will stop using my image/video/quote/case study etc. again but it may be impossible to remove all content that is already published.*

Yes

I agree to being contacted by a member of Jami, part of Jewish Care's Marketing team should they wish to ask me any further questions.*

Yes

I understand that my image and words will be stored and used for up to five years unless otherwise specified below*

Yes

Comments

If you want your image and words to be stored for less than five years, or if you have any other comments, please indicate below:

This permission form has been explained to me by:*

Signature of person:*

Signature of parent or carer:

If applicable

You can learn more about how we handle your personal data and your rights by reviewing our privacy notice

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If you are under 18, your parent/guardian should also sign the form

* This is the person who appears in the photography/case study or who has submitted his/her artwork/poetry etc. This form can be used for several members of one family.

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