LCGB Photo Consent Form ~ LCGB

From time to time we, as IBCLCs and aspiring IBCLCs, take photographic images (moving and still) of subjects, and use case studies which can include these images and personal data (such as name and/or condition in regards to infant feeding, where appropriate and consented to) to enhance and illustrate our progress in further developing our infant feeding and family support services. These images may also be used for teaching purposes.

By completing this form, you give us full permission to use these images and any personal information you supply to us in our media applications, which reasonably promote our aims as stated above. (This may include printed publications; publicity materials; audiovisual and electronic materials; display materials; teaching materials and any other media including social media, we may use in the future.) The images will not be used for any other purpose.

The copyright of any material which is generated as a result of this photographic session shall be assigned to and shall be the property of LCGB.

Thank you again for your help.

Parent's Name

First Last

Baby's Name

First Last

Address

Street Address Address Line 2 City County Post Code Country

Phone Number

Email

Enter Email Confirm Email

File Upload

Please state here if there are any ways in which you do not want us to use any photo(s) of you and/or your baby. i.e Facebook, Twitter, other forms of social media etc.

We will never give you or your baby's full name alongside any photograph or image.

If you would prefer us not to use your name at all please tick here.

Other than as specified above, the information that you give us here will only be used to contact you about these photo(s).

We will not pass the details recorded on this form on to any other organisation without your permission.

Consent*

Please tick to agree that we can use photos of you and your baby

Date