Media Consent Form

Little Hearts Matter produces a range of resources to communicate the power of the work we do, and encourage others to raise awareness and funds for the families that benefit from our work. We like to share the photos and stories of real people who have benefited from our services as it helps to demonstrate the difference we’re making. By completing this form, you give us permission to use your story in our communications. Thank you for your help.


We will always provide a copy of the way in which we’ve written your story, and you will have the opportunity to approve or change any details before your story is first published. We will always keep you informed of the ways in which we’re using your story or photo to check you are still happy to be involved. For more information on how we look after your data please see our Privacy Policy on our website.
Please tick the ways in which you’re happy for us to use your photo and/or story(Required)

I am happy to give my permission

Please sign below to show you give permission for your story to be used by Little Hearts Matter as outlined above. You can ask us to remove your story from our database at any time by contacting: | 0121 455 8982

If you are under 18, we need written permission from a parent, guardian or responsible adult.


Data protection: The information that you provide here will only be used to contact you about sharing your story in our communications work. We will not pass the details recorded on this form on to any other organisation without your permission.