MEDIA AND PUBLICITY CONSENT – KICKSTART

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Together Housing Group (Including Newground) would like to use these photos/videos in future to promote our services. By completing this form, you will be providing your consent for us to use these photos/videos of you for the purposes outlined here. For children and young people below 18 years of age, full parental/ guardian consent is required.

The information provided by you below will be kept securely and only shared with partners/ organisations we work with. Those partners/ organisations will only be able to use it for the same purposes as we have described below, and we will attach this form when sharing it. The information provided by you below maybe:

stored for up to three years. After 3 years we will delete it from our system or ask for further permission from you to continue usage.
used to promote or advertise Together Housing Group and its subsidiaries in its original or edited form, which may include but not be limited to; printed publications; signs; leaflets; adverts; website; social media; newspapers; television; radio and any other media we may use in the future;
(we may also) share, if it adds context, your name and location/event at which this photo/video was taken. (We will never share your full details/address)

Photo/video consent can be changed or withdrawn at any time by notifying Together Housing Group in writing, after which time Together Housing will no longer use or store your image. However, once information has been printed, distributed, or placed online, we may not be able to withdraw your image from where it has already been used, including internet sites. Therefore, please keep this in mind when providing consent. If you have any restrictions to how your image should be used please make us aware in the box below.

Are there any restrictions?*

Yes No

Do you want to opt in for marketing?*

Yes No

Personal details
*We must have some form of contact in case we need to query permission. It can be an address, email or telephone number, we don’t need them all.

My Contact Information
Title
First Name	Forename is required
Surname (s)	Surname is required
Address	Postcode: Building Name: Secondary Name: Street: District: Town: County:
Email Address	Email is required
Mobile Phone	Mobile is required
Date of Birth
Can we use your name in publications?	Yes No

Please note that our digital platforms include website and social media platforms that are viewable throughout the world, not just in the United Kingdom where UK Law applies. The data controller is Together Housing Group. Newground CiC and Newground together deliver programmes as part of that group, to benefit individuals and the wider community.

This form is valid for 3 years and we will seek renewed consent if the photographs are to be reused after that time. If you wish to withdraw your consent for any picture Together Housing Group will respect your decision and will not publish the image after that time. Thank you very much for your time and cooperation, may we wish you all the best for your future and hope you enjoy working with our team

Full details of how we use your data are contained in our Privacy Policy which is available at www.togetherhousing.co.uk/privacy-policy. You can withdraw your consent at any time by emailing communications@togetherhousing.co.uk or writing to Marketing and Communications, Together Housing, Bull Green House, Bull Green, Halifax, HX1 2EB.

Participant Signature

Name:
Signature:		Participant Digital E-Signature confirmation
Date:

Mentor Signature

Name:
Signature:		Mentor Digital E-Signature confirmation
Date:

Confirm and complete Media and Publicity Consent form information. If confirmed, this will prevent future resubmission of this form