Sands has a library of images and text containing photographs, personal experiences and poems.

Text and images from families are very useful in helping Sands to achieve its aims as they add depth and reality to the information on the Sands website as well as in our publications for bereaved families, health professionals, policy makers, potential funding organisations, the press and public.

We would be very grateful if you would give us permission to add your item(s) to this library as specified below.

If you have sent us images that include people other than yourself, your partner, your baby or your own children you should check that those individuals or the parents or guardians of any children are happy for the image to be used by Sands. Please check this before submitting this permission form.

Once you have completed the form and we have checked and added the details to our records we will email a copy of the information back to you for your records. We advise you to store this safely.

Once your material has been added to the library we do our best to contact you if and when we plan to use any of it, providing you make sure we continue to have up-to-date contact details for you. Material could be used in one or more of the following:

•Sands website

•Sands social media platforms

•Sands publications

•Sands awareness materials

•Sands internal and external presentations

We do not guarantee to use all the material sent to us. It will depend on what we need for each situation. Also if we do use your material we may want to add your name or the names of your babies. So please complete the section to indicate we have your permission to do this. You can withdraw your consent at any time, please contact Sands in writing at 28 Portland Place, London, WLB 1LY.

Section 1: About You

Title First Name Family Name…………………………….

Address……………………………………………………....

Town/County…………………………………………………

Post Code……………………….

Section 2: About your items

I am submitting: (please write yes or no next to the following options)

Photograph………………

Other Image…………………

Personal Experience…………………

Poem………………………

Description of item(s) being submitted…photos……………………………………………………

Section 3: About your consent

If you are submitting a photograph permission has been sought from everyone in the image (yes or not)……..

Sands may publish my name (yes or no)………..

Sands may publish my baby's name (yes or no) ………..

If you have indicated yes above please let us know how you would like the name(s) to appear………………………………………………………………………………………………….

Please indicate below if there is a Sands publication where we may NOT use your material:

Sands website

Footprints personal experiences booklet

Sands support literature for families

Sands literature for health care and other professionals

Sands awareness materials

Sands Facebook page

Sands internal and external presentations

Other media

By submitting this form you agree to Sands having permission to use the materials described until such time as you withdraw your consent in writing. Sands will endeavour to contact you before using the material, however we are unable to guarantee any or all items will be used.