2025 Consent Form

Photographer's Name

Hospital Name

City and State of Hospital

First Name

Last Name

Email (your photos will be sent here)

Phone

Baby's name (optional)

Gestational age of infant at birth

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

Bereavement photography and video consent. Bereavement photos and videos 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. Please sign below.

Is there anything else we should know?

2025 Consent Form

Little Lights Photography