Community photo submission

About you

Full name

Phone number

Email

Address

About the image

Location

Approximate date taken

If people are visible and recognisable, have they given permission for the media to be shared?

Please confirm that you are the owner of the media you are sharing, and have the right to share.

Credit

Where possible, we would like to credit you for your images. Please indicate if you would like to be credited, and if you are only happy that we share your image when crediting is possible.

If you would like to be credited, please indicate the name would like to be credited

We would like to tag you if we share your image/s on social media. If you would like to be tagged, please share your social media handles below.

Consent

I give consent for Project Groundwater to publish, republish or otherwise transmit still and moving images and audio taken by myself for the purposes of:

I understand that still and moving images and audio will be stored electronically in accordance with Data Protection laws and may be used for up to four years from the date of signing. I have the right to withdraw this consent at any time by contacting Project Groundwater via hello@projectgroundwater.co.uk or, if the project has ended, contacting Buckinghamshire Council via communications@buckinghamshire.gov.uk or calling 01296 382444 or 01296 395000.

Confirmation

I understand the above request and give informed consent.

Date

Signature

Select your photo:
Have more than one photo to submit? Complete this form, attach one photo and email the rest to hello@projectgroundwater.co.uk