Press Consent Form

Please note that we will only pass your information onto third parties with your consent or where
we are required to do so by law.

Name:
Organisation:
(if any)
Address:

Postcode:

Tel: Mobile:

Email: Age:

The Diana Award may wish to tell your story and/or use your photograph in the circumstances set
out below. Please can you indicate whether you would like us to do this or not, by ticking the
appropriate box below:

1. May the Diana Award tell your story, video and/or photograph in our published printed
materials? For example, in a leaflet to promote the Award or on our website.

Yes  No 

2. May the Diana Award pass your story, video and/or photograph onto the media (for
example your local newspaper or TV station)? If used by the media, we would contact you
to let you know when and where your story will appear.

Yes  No 

The Diana Award also works alongside other organisations such as funding bodies, charities,
schools and colleges who also sometimes use the photographs, videos and/or stories of the young
people that have received Diana Award.

3. Would you be happy for us to pass your story, video and/or photograph to these
organisations for them to use in published materials and/or on their website? If this
happens , we will contact you to let you know when and where your story will appear.

Yes  No 
4. Are you happy for your full name and location to be mentioned in the story or article that
appears in the media (For example this could be a newspaper or TV programme)
 Yes  No 
If no, please detail how we should refer to you below:

Additional Comments:

Consent

I understand my right to ask to see any information held about me by the Diana Award.

I also understand that whilst the Diana Award makes every effort to ensure that all media coverage
portrays interviewees in a positive way, the Diana Award does not have final control over how a
journalist may portray me.

Signed: _______________________________________________

Print Name: ____________________________________________

Date: _________________________________________________

Parental consent

If you are under 18, please ask a parent or guardian to sign this form. However, if you are above
18, you can sign and return it yourself.
delete as appropriate
I_____________________________________________, parent/guardian*

for ___________________________________________________________

give permission for the photographs, stories and or videos of the above named person(s) to be
used only as marked in questions 1 to 4 above.

Signed: _______________________________________________

Print Name: ____________________________________________

Date: _________________________________________________

If you have any queries or would like us to explain any aspects of this form please
contact Katie Marple at the Diana Award on
020 7484 0524 or by email: Katie.marple@diana-award.org.uk