This document is an image/video consent form for Fastbleep Ltd. It requests information about the subject, material, and originator. It details that the material may be published on Fastbleep's website and other publications for educational purposes. It also specifies that the subject's consent can be revoked before publication but not after. The subject must sign to consent to their images being published.

1. Fastbleep Ltd
Image/Video Consent Form
Consent for the publication of images/video of them by Fastbleep Ltd.
To be completed by the corresponding author:
Subject matter of picture, photo
or video (the “material”):
Name of originator:
Address of originator:
Title of material:
To be completed by the subject:
I give my consent for this material to appear on fastbleep.com and associated
publications. I have seen any pictures, photographs and videos and read the material to be
published.
I understand that:
 The material may be placed on Fastbleep Ltd’s website (fastbleep.com). The
website’s intended audience is healthcare professions students, applicants to
healthcare courses and healthcare educators though it may be freely accessed by
others;
 The material may also be used in full or in part in other publication and products
published by Fastbleep Ltd. This includes publication in English and in translation, in
print, in electronic formats, and in any other formats that may be used by Fastbleep
Ltd now and in the future.
 The material may be used for advertising or packaging, but only in relation to
Fastbleep projects;
 The material will not be used out of context;
 This consent form will be retained by the originator, and a copy sent to Fastbleep
Ltd.
 I can revoke my consent at any time before publication, and without giving a reason.
Once the material has been committed to publication, it will not be possible to
revoke the consent.
 I consent for photographs of me participating in a ‘Fastbleep Foundation’ session
to be published: (please print YES or NO): ________
Name of subject
Signed: Date: