Story, photo and film consent form

By completing this form you’re providing consent for Teenage Cancer Trust and selected corporate and media partners to feature your story (including your written story, film, image, audio and/or recording) to promote our work supporting young people with cancer.

Use of your story

Please read through the following and tick all that apply to you

I’m happy for Teenage Cancer Trust to feature my story (including my written story, film, image, audio and/or recording) in publicity and communication materials for up to five years.

I’m happy for Teenage Cancer Trust’s selected partners and the media to feature my story (including my written story, film, image, audio and/or recording) in publicity and communication materials for up to five years.

I’m happy for any photos or video footage I’ve provided to be used in Teenage Cancer Trust’s general communications (otherwise, we’ll only use your photos/video alongside your story).

(For young people supported by Teenage Cancer Trust) I agree to Teenage Cancer Trust and my clinical team discussing my personal circumstances if necessary, to make sure the treatment I am undergoing, or have undergone, does not affect my involvement.

Are you under or over 18?

If you’re under 18, your parent or guardian needs to fill out the next section

Under 18

Over 18

Young person's details

This section needs to be filled out by parent/guardian

Your details

First name

Last name

Pronouns (e.g. she/her, he/him, they)

Date of birth

Email address

Phone number

Your address

Address line 1

Address line 2

City/Town

Region

County

Postcode

Country

Click here to enter your address manually.

About their treatment

(for young people supported by Teenage Cancer Trust)

About your treatment

(for young people supported by Teenage Cancer Trust)

Key Teenage Cancer Trust contact

Hospital

Parent/guardian details

Title

First name

Last name

Relationship to young person

Email address

Phone number

Data protection and confidentiality statement

By ticking this box, I confirm that all the information provided is true and accurate and I am happy for my story to be shared.

Teenage Cancer Trust respects your privacy and values the trust you place in us when giving personal information. We work within the guidelines of the Access to Health Records Act 1990 and the General Data Protection Regulation. The information you have provided will be kept by Teenage Cancer Trust and will be treated with the strictest of confidence. It will not be shared with a third party without your consent unless we have a statutory obligation to do so and there are concerns for your safety of which Teenage Cancer Trust has a duty to report this to the relevant authority in order for appropriate action to be taken. For more information on how we use your data see our Privacy Policy on our website.

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