Consent For CYP Art Exhibition Argenta

Consent for Art Exhibition

This form should be completed if you are exhibiting in art shows, in addition to the ‘Consent to Publicity’ form.

Name of child/young person taking part*
First Last
Date of birth*
Name of person cared for by Havens Hospices*
The child's relationship to the person cared for*
Contact details of person giving consent
Name
Title First Last
Address
Street Address Address Line 2 County Post code
Home phone number
Mobile phone number
Email*
Relationship to child/young person
I am happy for my young person's artwork to be displayed in the following exhibitions.
- Argenta London Offices
Please note that the information previously agreed to and used for the bio will be displayed alongside the piece of artwork
Are you happy for your young person to be featured in the media? E.g. social media/Echo/local news websites.
- Yes
- No
If yes, please complete our consent for publicity form too
Declaration
I have read and understood the above and I give permission for Havens Hospices to use the information and artwork in line with the above decisions. I understand artwork can be collected from Little Havens one week after the exhibitions you have consented to have finished. Artwork will be kept for a maximum of one month and recycled if not collected in that time.
Parent/Carer Full name – this will be used as your electronic signature*
Consent*
I agree that my full name in the field above will be used as my electronic signature
Date*