Little Lights Photo Consent

The Little Lights Program is a hospital infant bereavement photography program that is provided by your hospital and/or local professional photographers. High quality photos are captured by the hospital staff for you during an infant loss. For more information about this program, please email capturinghopesdirectors@gmail.com. The Little Lights Program is a family support program created by Deneen Bryan with Capturing Hopes Photography Inc to further aid families during their infant loss.

If you have more questions, please check out our FAQ page HERE

Hospital Name

Hospital City, State

Mother's Name

Last Name

Email (your photos will be sent here)

Phone number

Alternate Email

Alternate Phone number

Baby's Name (optional)

Date of birth or due date

Photography Permissions: I hereby grant permission for the medical staff member or photographer to photograph my infant and any family members included in the photography session.

Photography Permissions Signature

Support Person Permissions: If the photographer is not part of the medical staff at the hospital that I deliver at, I hereby grant permission to allow them to enter the hospital as a guest of mine and consider them a necessary support person during my loss.

Signature

Financial Information: I understand that at no time will I be charged a fee by the medical staff or professional photographer. This is a free support program that provides both a full photography session and free high resolution image downloads at no cost to the family. *A donation to Capturing Hopes can be made by the family at our website if you choose to, however, this is not expected or required at any time.

Financial Information Signature

Photo Usage Permissions

Bereavement photography and video are used to further train the bereavement community in the importance of photography during child loss. Education in this area is important for hospital staff and photographers to be able to continue to provide this free support program to grieving families.

Please sign below if you consent to allow your photo session to be used to educate and train within the bereavement community. This includes in print form, website, social media platforms, bereavement education conference material, and media. I hereby understand that at no time will my baby or family's private information be used publicly during education and training for bereavement photography.

Photo Usage Signature

Please list any questions about the above information that you have here

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Little Lights Photo Consent

Little Lights Photography