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Media consent form

If you have any other queries, or wish to speak to someone at RNIB before completing the form, please email [email protected].

  1. I give my permission to you, Royal National Institute of Blind People (RNIB), to use my stories, quotes, and photographs/video film/audio. I hereby grant RNIB 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 RNIB’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 RNIB and its work.
  2. I understand that I do not own copyright or have any rights of ownership or other claim over the images.
  3. I understand that RNIB will keep all the images and story content and use them for an indefinite period, but that I can withdraw my consent in writing at any time – this can be done by emailing [email protected] or writing to Stories Library, The Grimaldi Building, 154a Pentonville Road, London, N1 9JE .

While we have taken care to ensure this form is accessible, please get in touch if you have any problems completing it. Alternatively, screen reader users might find the word version linked below more accessible. Please return completed forms to [email protected]. If you have any other queries, or wish to speak to someone at RNIB before completing the form, please call or message us on 07753 100205 or email [email protected].

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. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Click here for the Word version of the form.

Fields marked * are required.

Date of Birth *

About You

Information about your V.I. and RNIB Relationship
Registration (CVI) *
Are you *
Services used at RNIB *

The name of the person who referred you to this form
Are you interested in helping RNIB in the future i.e. speaking to the media or Taking part in RNIB organised events? *

Witnessing Consent

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

Can we keep you up to date?

We seek to create a more inclusive world for blind and partially sighted people, and this begins with being there for anyone affected by sight loss. We’ll use the information you provide to send you occasional updates by post or phone about the support we offer that you’ll hopefully find useful, and share all the ways you can engage with and support our work.

Are you happy to hear from us by email and text?

We promise to keep your details safe and never sell or swap them with anyone. Our privacy policy explains how we use your personal information. You can also opt out if you don't want to hear from us by post and phone, or change your mind about how we contact you.

You can also email [email protected], call 0303 123 9999 or write to us at RNIB, The Grimaldi Building, 154a Pentonville Road, London, N1 9JE.

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. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.