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The home of the Clowndoctors and the Elderflowers, Scotland's healthcare clowns.

Clowndoctors - Photography/Video permission form

As part of our communications and marketing activity, Hearts & Minds uses photography and video for publicity and awareness-raising purposes. We would like your permission to photograph and / or video your child/ward for possible inclusion in our promotional platforms – website; social media; YouTube Channel; presentations and press opportunities.

The image(s)/film footage will remain the property of Hearts & Minds and will be used for the designated purpose of promoting Hearts & Minds in relation to promoting the quality of life and wellbeing of children through the Clowndoctors programme. Your contact details will remain strictly confidential. Please note that although we have a signed permission slip we cannot guarantee the undersigned will appear in visuals, due to the nature of editing.

This is a required question
This is a required question

Name and details of family member/guardian giving permission

This is a required question
This is a required question
Find Address by Postcode or Street:
Please fill in Address Line 1, Town/City, and Postcode.

More detail on use of photographs / video

Photographs / video may be used by Hearts & Minds

  • May be used on our website/social media.
  • May be considered for press releases and published in newspapers.
  • May be used in fund-raising campaigns and in fundraising applications.
  • In publications, for example in newsletters or annual reports, which may also then be available on our website.

Should you give your permission for photographs and or video to be taken and/or used and then change your mind at any point, please contact us and we will remove your consent for future purposes.

Thank you for taking the time to complete this form.

(NB This list is not exhaustive.)

I permit Hearts & Minds to use photographs and or video of my child/relative/patient in Hearts & Minds publications, website and other general publicity material. I confirm that I have the authority to give permission for Hearts & Minds to use the photographs and / or video, on behalf of the person photographed. *

This is a required question
Hearts & Minds Hearts & Minds, Lower Ground, 4 Castle Terrace, Edinburgh EH1 2DP
0131 229 4037 | info@heartsminds.org.uk
Registered Charity No. SC027040

Thank You!

Your response has been recorded and safely stored in our system.

Submitted Details Summary

Name of person photographed / filmed: -
Filming Location: -
Name (Family member / guardian): -
Email: -
Contact number: -
Address: -
Digital Signature: ✓ Confirmed & Signed
Permission to be named: -
Record Reference: -
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