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

Young person's details

This section needs to be filled out by parent/guardian

Your details

Your address
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)
Parent/guardian details

Equity, Diversity and Inclusion 

At Teenage Cancer Trust, a key priority for us is challenging inequality and creating an inclusive culture across all our areas. We want to make sure we represent all communities and identities in our storytelling to help us towards our mission of supporting all young people in the UK with cancer, no matter who they are.

The following questions are optional and if you answer them we would like to include them in your story.

What pronouns do you use?
What is your gender?
Are you trans or do you have a trans history?
Do you consider yourself to be neurodiverse? (eg. autistic spectrum condition, dyslexia, ADHD etc)
If you describe your sexual orientation with another term, please provide this here:
Which of the following best describes your ethnic group?
What is your religion?
Data protection and confidentiality statement
Please be aware that the Storyteller role is a public-facing role. As such, we may carry out some due diligence when people sign up to the role looking at information in the public domain (such as searching news stories) to ensure we can protect the reputation of Teenage Cancer Trust and the work we do. We commit to being transparent and discussing any such due diligence searches with you. If there is anything you would like to discuss relating to this due diligence procedure, please contact [email protected]. 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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