Submit your Story of PPROM below.

Please sign the form below to grant us permission to use on our website and social media accounts 

Photo/ Image consent form

FOR CHILDREN AND YOUNG PEOPLE UNDER 18 YEARS OF AGE

Thank you for helping us.

At Little Heartbeats we produce a wide range of materials to tell people affected by PPROM about our services and to raise money for our work.  From time to time we will take photographs of individuals and groups, audio and video clips and use case studies which can include these images and personal data, such as name, and any details provided regarding you and your child’s PPROM journey (“the information”).

For children and young people below 18 years of age, full parental/ guardian consent is required.   Each child/ young person must have a copy of this form signed by the parent/guardian prior to the shoot/ event.

The information provided by you about the young person named below will be:

 

  • stored and used for the purpose of making our media applications more accessible, inspiring, and motivating for our audience;

  • used to promote or advertise the aims of Little Heartbeats, which may include our printed publications; website; adverts; audiovisual and electronic materials; media work; display materials; briefing of staff, potential donors and agency partners; and any other media we may use in the future;

  • be kept securely and only shared with our suppliers or partners who work on our behalf or with us to deliver and improve services for people affected by PPROM; and

  • (It may also be) made available for Little Heartbeats Professionals (such as our Little Heartbeats team) or for our fundraisers to use.

 

Image consent can be changed or withdrawn at any time by notifying Little Heartbeats in writing however, once information is placed on the internet, we do lose a degree of control over the distribution and retrieval of such information. This could mean that even if we stop using your images it is possible that it may still be available on the internet.  Therefore, please keep this in mind when providing consent.  We never sell or swap your details with third parties.

 

Thank you again for your help.