Media Consent

Please read and complete the following form and then click on SUBMIT.

Please complete this form to give consent for us to take and store images, moving footage, audio, comments and other personal data to be stored and used for internal and external communication.

While we have taken care to ensure this form is accessible, please get in touch if you have any problems completing it. If you have any other queries or wish to speak to someone in the Difference Team before completing the form, please email

Media consent form

  1. I give my permission to you, Reconciling Leaders Network (RLN) to use my stories, quotes, and photographs, video film or audio. I hereby grant RLN and any third party assignees or licensees the absolute right to use the stories, quotes, audio and images resulting from the interviews and photography/video shoots, and any reproductions or adaptations of the images for any purposes in relation to RLN’S work including, without limitation, the right to use them in any advertisements and other publicity materials, direct mail, books, newspapers, magazine articles, television programmes and internet publications to promote and raise awareness of RLN and its work.
  2. By giving permission, I understand RLN will keep all its images in accordance with data protection law and archive the images that have not been used for any publicity or marketing after two years. I also understand that the still, moving images or audio used for publicity or marketing purposes are in the public domain and therefore could potentially be reproduced, altered or re-used by anyone in the world outside of RLN’s control. I know I have the right to withdraw consent at any time by emailing but understand that withdrawing consent may not affect the material that has already been used.

Witnessing consent - U18 only

This section must be completed by the parent or guardian of someone under 18 years or by a person with authority to sign for someone who cannot sign for themselves.

I am the parent or guardian of the person identified in Section A. I understand the above request and give informed consent for this young person’s image/data to be used as listed above.

Address of person witnessing consent

We are committed to protecting your privacy and want to assure you that your personal information is safe with us. For more information, please read our privacy policy.

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