Using images of adults

Consent form for County Council staff commissioning photography

To Name : Address :

Contact tel no: Location of photograph: Hampshire County Council would like to *take your photograph / *make a video/webcam recording of you for promotional purposes !hese images may appear in our printed publications" in press releases" on video" on our website" or on all four * (*Please delete as appropriate.) !o comply with the #ata $rotection Act %&&'" we need your permission before we take any photographs or recordings of you $lease answer (uestions % to ) below" then sign and date the form where shown *e will not use the images taken" or any other information you provide" for any other purpose Please return the completed form to:

(Insert the name of the staff member commissioning the photography and the return address.) Please circle your answer % +ay we use your image in printed publications produced by Hampshire County Council for promotional purposes, +ay we use your image in press releases" which may subse(uently appear in the local or national media, +ay we use your image on our website, Yes / No

Yes / No

Yes / No Yes / No

) +ay we record your image on our promotional videos,

Please note that websites can be seen throughout the world, and not just in the United Kingdom, where UK law applies.

Form UIP3

Please also note that the conditions for use of these images are on the bac of this form. / have read and understood the conditions of use on the back of this form 0our signature: 0our name 1in block capitals2: #ate:

Form UIP3

Conditions of use
% !his form is valid for *two years from the date of signing / *for this pro3ect only 0our consent will automatically e4pire after this time - *e will not re5use any images *after this time / *after the pro3ect is completed . *e will not include details or full names 1which means first name and surname2 of any person in an image on our website" on video" or in printed publications" without good reason 6or e4ample" we may include the full name in a press release or of a competition pri7e winner if we have their consent However" we will not include the full name of a model used in promotional literature ) *e will not include personal e5mail or postal addresses" or telephone or fa4 numbers on video" on our website or in printed publications *Please delete the option that does not apply.