CONSENT FORM TO USE AN IMAGE OR PHOTOGRAPH OR VIDEO OF AN INDIVIDUAL

We take the issue of data protection very seriously and we would never knowingly use an image or
video of you without your prior consent.

Please print all details in the white space below, except where otherwise stated.

Your Name: ……………………………………………………………………………..

Telephone No: ………………………………………………………………………….

Email Address: ………………………………………………………………………….

I understand that this image, photography, video and/or my name will only be used for the following
purposes:

 Promotional materials for the Pets at Home Vet Group (encompassing the “Vets4Pets” and/or
“Companion Care” brands) conducted through any of the following mediums:
o television advertisements broadcast on UK national television channels or networks,
o online advertisements and/or displays on websites owned and run by Pets at Home
Vet Group Limited,
o posts and/or advertisements on Facebook, Twitter, Instagram, and/or any other social
media platforms used by Pets at Home Vet Group Limited,
o electronic and printed information, displays and exhibitions relating to the activity
shown in the video or photograph,
o print and electronic promotional literature, including brochures and posters,
 Any similar campaign or related area, and
 Future marketing and/or publicity for Pets at Home Vet Group Limited, any of Pets at Home Vet
Group Limited subsidiaries, its ultimate holding company and any subsidiary of its holding
company and Support Adoption for Pets only.

I understand that this image, photograph and/or video will NOT be used for:

 Anything which may be viewed as negative in tone or that may cause offence, embarrassment
or distress
 New marketing or publicity campaigns for the Pets at Home Vet Group commencing after the
date that falls two years from the date of this consent form. Please note that any ongoing
campaigns commenced before this date will continue to run after this date until their
conclusion.

Having read the statement above, do you give your consent for this image, photograph and/or video to
be used?
(Please put a tick in the appropriate box)

YES, I give my consent for the image, photograph and/or video to be used

NO, I do not give my consent for the image, photograph and/or video to be used

Do you give your consent for this image, photograph and/or video to be used with your full name?
(Please put a tick in the appropriate box)
 YES, I give my consent for the full name to be used

NO, I do not give my consent for the full name to be used

You can withdraw your consent at any time. Withdrawing your consent will not affect the lawfulness of
any processing we have conducted prior to your withdrawal. Please see our privacy policy at
https://www.vets4pets.com/about-us/privacy-policy/ for our contact details.

Your Signature: …………………………………………………………………………

Date (DD/MM/YY): …………………………………….