Media Consent Form printable pdf download

Media Consent Form

Media consent form

We’re always looking for stories to help raise our profile.

This could be in the local community or nationally.

We’d like to hear about newsworthy challenges e.g. a heart-warming story, a personal achievement,

a world record attempt or even something that has never been tried before. If you would be happy to

speak to our Press Office regarding your challenge, please fill out and return this form. All information

will be kept confidential and we will not pass on your details without your consent.

1. Your details

Full Name

Mr / Mrs / Miss / Ms

Address

Post Code

Contact Telephone

Date of Birth

Occupation

Place of work

2. Your event

Your event / activity

Please tell us about your fundraising, including what, where and why it’s different?

Why have you chosen to fundraise for Caudwell Children?

I confirm that Caudwell Children may contact me about publicising my challenge activity.

Signature:

Date

Many thanks for raising funds for Caudwell Children.

Please return your completed for to: Challenges Team, Caudwell Children,

Minton Hollins Building, Shelton Old Road, Stoke on Trent, ST4 7RY.

01782 600 112

caudwellchildren

@caudwellkids

ISO 9001 Certiﬁed Quality Management System

company no. 3864620

RCN 1079770

SC 043874

Media Consent Form