Consent for stories and images

I give consent for images, written quotes, video or sound recordings of me or my next of kin to be used for the purpose/s outlined above, which has been fully explained to me. I agree that the images, written quotes, video or sound recordings may be cut and edited for the programme or associated publicity material. I understand that this contribution may not appear. I also understand that if this material is being sought by a third party, my consent may not be withdrawn after this date. I understand that Herriot does not control the use or disclosure of any information about me or images of me resulting from the purposes above and I release Herriot from all liability for such uses or disclosures. Your case study may be used for regulatory and monitoring purposes – for example, with the Care Quality Commission (CQC) – demonstrating quality and standards of the care we provide. For this purpose, this would be anonymised and only shared with the regulatory body concerned. This would be held on a private server and wouldn’t be shared via public forums. Possible use of your non-anonymised case study publicly is dependent on which channels you opted-in or out of above. I confirm that I am at least 18 years of age.

For further information, or to discuss anything contained in this document, please email commsteam@saintmichaelshospice.org

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North Yorkshire Hospice Care is a registered charity in England and Wales (518905) with a family of services operating as Herriot Hospice Homecare, Just ‘B’, Saint Michael’s Hospice and Talking Spaces. North Yorkshire Hospice Care is a company limited by guarantee, registered in England and Wales (2121179). Registered address Crimple House, Hornbeam Park Avenue, Harrogate, HG2 8NA.