CONSENT TO USE IMAGE/VIDEO FOOTAGE

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					                        PROTECT – PERSONAL
                                                                FM/11/1/6
                                           Author: MarComms, Photographer
                                                              Page 1 of 2




Consent to use image/video footage

Verbal consent only        Yes/No

Date of consent


Name of subject (s)                     Age


Address




Contact telephone number (s)            Incident no./Event name


E-mail address


Description of image/video footage




Image library reference number


I/We consent to Hampshire Fire and Rescue Service using the *image/video
footage (*delete as applicable) identified above, for a period of up two years
from the date given on this form, for publicity purposes, which may include
giving permission for other organisations to use them.
I understand that publicity may include any or all of the following media, and
that you will re-apply for my permission if you wish to use this image/video
footage beyond two years:
Online and printed brochures/flyers/newsletters, exhibition stand
graphics, web site, staff magazine, promotional videos/DVDs, local,
regional and national newspapers, trade magazines.
                                                                          FM/11/1/6
                                                     Author: MarComms, Photographer
                                                                        Page 2 of 2


Signature of subject (or photographer if permission is verbal)



Signature of parent/guardian/headteacher (if child or vulnerable adult)




Hampshire Fire and Rescue Service supports the objectives of the Data Protection Act 1998
and is registered as a data controller. Information which you provide will be governed by the
requirements of the Data Protection Act 1998 and may be processed by the Service in the
performance of its statutory duties or for purposes required by law. More information is
available at www.hantsfire.gov.uk/dataprotection.

				
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