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

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:

Bliss aims to increase web accessibility by including a short description of the people in the images we share. This helps those with sight loss or reduced vision to gain a clearer understanding of the image.

If you would like to contribute, please include a short descriptor of yourself that you would be happy for us to include alongside any photos you provide. For example: Woman in her thirties of Asian heritage.

Would you be happy for the hospital to use your content?

If you are taking part in a video or photoshoot at a neonatal unit, please tick 'yes' if you give your permission for the hospital to use content relating to you and your baby for their purposes as well as Bliss. This includes but is not limited to, the hospital website, marketing materials and social media channels.

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?

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.

I give my consent for Bliss and Bliss Scotland to use or capture footage, audio, photographs, words and other types of media (hereafter known as content) in accordance with my choice as indicated on the above form. This consent is given indefinitely but I can withdraw it at any time by emailing [email protected]. If applicable and appropriate, I have discussed the above with the child's other parent/s or guardian/s. I am over 18 years of age.
I give my consent for Bliss and Bliss Scotland to use or capture footage, audio, photographs, words and other types of media (hereafter known as content) in accordance with my choice as indicated on the above form. This consent is given indefinitely but I can withdraw it at any time by emailing [email protected]. I am over 18 years of age.
Please tick the box to confirm you have read and agree to the above 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 Supporter Promise. If you have provided a postal address we may occasionally contact you by post, but you can opt out of all communications from Bliss at any time by calling us on 020 7378 1122 or emailing [email protected]