Home > Support > Your stories > Multimedia consent and release form

About you

Name 

We'll only use this to contact you with relevant information and if you opt-in to receive other Bliss updates.

How would you describe your connection with neonatal care? 

Please select all that apply to you.

Start typing your address and select the correct address from the results returned.

Address

Start typing your address and select the correct address from the results returned.

Your workplace address

Your consent

Bliss uses your content to support its charitable work, including raising awareness, fundraising and sharing information about our services.

We will keep and use your content for as long as it remains relevant to our work. This consent does not have a fixed expiry date, and you can withdraw your consent at any time by emailing us.

What kind of content do you consent to Bliss using? 

Please select all that apply to you:

What kind of content do you consent to Bliss using? 

Please select all that apply to you:

Would you like to share your family's neonatal experience for the Your Stories section on Bliss's website?

We share stories of parents and carers with neonatal experience at bliss.org.uk/your-stories. Let us know if you are happy for your content to be shared here.

How would you like to submit your written story to Bliss? 

Feel free to share what you have so far and we will be in touch with you to help you finalise your story.

Would you be happy for your story to be used as a media case study? 

A media case study is someone willing for their story to be included in a Bliss press release, or to be interviewed by a media outlet about their experience of having a premature or sick baby.

Your story could be used in media outlets including TV, radio, print and news websites. We will contact you before agreeing to anything with a journalist, so you remain in full control and can decide whether you would like to participate.

We will support you at every stage. Agreeing to this means you give us permission to contact you about any future media opportunities.

Have you had any media coverage of your story before?
What will my content be used for? 

Please select the options you are happy with:

Are you happy to be contacted to take part in media opportunities (e.g. TV, radio, digital)

Please list anything here. For example, this could include your location, or the age of your children (if applicable).

Please list anything here. For example, this could include your location.

Please tick the box to confirm you have read and agree to the below consent statement: 

Let's keep in touch

Your support helps the most vulnerable babies in the UK. We’d love to keep you updated with news about our work and ways you can get involved with Bliss. Are you happy for us to contact you:
By email
By phone
By text

Your privacy


We (Bliss and Bliss Scotland) promise to keep your details safe and never pass them on to third parties for marketing purposes. Find out how we look after your personal data in our Privacy Policy. If you have provided a postal address we may occasionally contact you by post. You can opt out of all communications from Bliss at any time by calling us on 020 7378 1122 or emailing us.