Novant Forsyth Medical Center Photo Request

Capturing Hopes and Hope Photo are nonprofit photography programs supporting families during their child’s stay in the hospital. All photography is donated by local professional photographers. As a recipient of this gift of photography, you will receive 5 free digital photos per photo shoot that your child receives. Families of premature babies may receive a photo session once every two weeks, and all other child recipients may receive a photo session once a month, unless a special occasion/holiday requires it to be sooner. If you would like your child to receive a photo session with your hospital’s hope photographer on the next session date, please fill out the form below.

Hope Photographer: Deneen Bryan with The Cuddles Company LLC and Hazel Grace Photography

Guardian's First Name

Guardian's Last Name

Relationship to Child

Child's Full Name (as used on hospital records)

Email (photos will be sent here)

Phone

Hospital Unit (NICU, PICU, Peds, HEMOC, etc)

Room or Bed Number

Social Media Sharing Permissions and Information.

Please include below any information that you are comfortable with Capturing Hopes or Hope Photo sharing about you or your family on our social media. This is an optional question, we do not want to invade your privacy in any way if you choose not to answer. By filling these in, you are agreeing to allow us to share the below information.

Child's Current Age

Diagnosis (if any)

Upcoming Surgeries

Previous Surgeries

Current Weight (NICU)

Weight at Birth (NICU)

Child's Name

Other Info

Copyright and Permissions Information:

Your photographer will email a beautifully edited photo gallery of images from your child’s session free of charge to you. All photos are high resolution and can be downloaded and printed by anyone that you allow to access the gallery. Capturing Hopes and Hope Photo remain the sole copyright owner of the photos and must be credited in any promotional medium that the photos are used, including but not limited to: news articles, online blogs, magazines, hospital promotions, news media stories, business promotions, and photo competitions. Capturing Hopes/Hope Photo must give written permission for any photos to be used in any of these mediums and must have knowledge prior to use. Please sign below indicating that you understand both the copyright and printing rights included with your photo session. NOTE: This must be signed prior to booking a session with Capturing Hopes/Hope Photo Photography.

Digital Signature

Date

Please sign below indicating that you agree to allow the Capturing Hopes/Hope Photo affiliated photographer permission to photograph your child/family while in the hospital. All photos remain the copyright owner of the organization and may be used to promote the organization’s mission of spreading hope to families. Your child’s name and your family name will not be used at any time during the use of the photos, unless you have granted permission above.

Capturing Hopes is a nonprofit organization that depends solely on donations from the community. Are you interested in information about making a donation at this time?

IMPORTANT: Once you submit this request, you will get an email with one last step to get on the session schedule for this week. Please make sure to fill that short form out after completing this one.

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Thank you for contacting us!

LAST STEP: Get on the schedule for your hospital HERE

Thank you for your submission, please read the information below to prepare for your child's session.

IMPORTANT

- A parent or family member must be present at the time of your child’s session.
- After your child’s shoot, you may find sneak peeks of your session on our social media (Facebook: Capturing Hopes/Hope Photo) or on our website.
- You will receive an email with 5 edited digital photos within 7 days of your session.
- If you have any other questions, please text Deneen at 336-710-7026

To make a donation, please visit our website: www.capturinghopesphoto.org

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