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GETTING INVOLVED

Consent

DIGITAL MEDIA CONSENT FORM

Please complete this form to indicate you are happy for pictures or videos of you to be used to promote Barnsley Hospital in print and digital media.

Name
Address
Terms and Conditions
It has been explained to me and I understand that any photos or videos taken of me will be used to promote services or other initiatives of Barnsley Hospital Charity. I understand that all or part of the video/photographs may be used in conjunction with other forms of illustration and text within Barnsley Hospital Charity publications, advertising or any form of digital media.

I understand that the general public worldwide may see the images. I understand refusal to consent will in no way affect my clinical care. I hereby give my informed consent for images to be taken of me and used by Barnsley Hospital Charity as set out above. I know I will not be paid for images to be taken and used. And I am giving this consent freely and without any expectation of more, or better treatment from the NHS because of it. To be completed by person named above, their parent, guardian or carer as appropriate:

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