Media Consent Form

Providing informed consent for use of your image, video, audio or story

What am I being asked to sign?

Thank you for supporting the work of the Mater Hospital Foundation. Sharing news, stories and updates from the Mater Public Hospital is an important part of the work we do to help raise vital funds to support patients and their families. We do this by communicating via the media, on social media, in our printed materials and with our supporters and the wider public.

In this form, we are asking for your permission to use photographs and / or videos and / or audio recordings in which you are featured. We
take this responsibility very seriously. Some examples of how we may use photos / videos / audio recordings include:

Print (e.g. newspapers and magazines) and broadcast media and associated websites

materfoundation.ie website

Mater Hospital Foundation social media channels

Mater Hospital Foundation publications (e.g. Impact reports, brochures, banners, leaflets etc.)

Mater Hospital Foundation advertising campaigns

All personal data that the Mater Foundation use will be collected and stored in accordance with the provisions of the EU regulation 2016/679 General Data Protection Regulation and your rights under GDPR. Please also refer to our Privacy Statement.

Your Permission

This consent form is to be completed by the featured individual before content is published, or by parents/guardians if the subject is less than 18 years of age.

Media Consent Form

Check the box if completing consent form on behalf of a minor

Not Applicable

Consenting on behalf of a minor

Your Name(Required)

Email(Required)

Telephone Number(Required)

MMUH Department (if applicable)

Project (campaign, initiative, event)

I understand that this photograph / video / audio recording / story can be used for a period of up to two years:(Required)

Tick to accept

I understand that I can make a request to the Mater Hospital Foundation to review my decision during the two-year period:(Required)

Tick to accept

The purpose that I have been interviewed / or photographed / or video recorded / or audio recorded for, has been fully explained to me and I hereby grant permission for use of this photography and / or video and/or audio material / or content for the purpose stated above:(Required)

Tick to accept