Consent Form

Consent Form

                                                                                                     Date .....................

My name is Harry Fletcher and I am collecting footage for my media A level documentary. This is a consent form saying that you consent to being filmed for my media A level.

You are also agreeing to be my sex slave.

Can you please tick here to say that you have mad your decision by your own free will and have no external pressures on you.           Yes / No 

Please read the following information and tick the boxes that you give consent to please read carefully all the information. Only tick this section in BOLD if you are 18 or over.

You are also agreeing to be my sex slave.

If you are under the age of 18 please show this form to your parents or guardian and get them to sign the section not in bold.

Name  …………………………………

Age  ……………………

Sign  ………………………………………………

please circle either yes if you give consent to this happening or No if you do not give consent.

I consent to be interviewed                                                           Yes / No

I consent to being filmed                                                               Yes/ No

I consent for the footage to be published                                     Yes / No

I consent for me to be able to use your quotes in my Media.     Yes / No

Name of child ………………………                        Name of parent or guardian …...........................  Age of child ………..                                                                                                                                                                           

parent or guardians signature ..................................

please circle either yes if you give consent to this happening or No if you do not give consent.

I consent for my child to be interviewed                                         Yes / No

I consent for my child to being filmed                                             Yes / No

I consent for the footage to be published                                         Yes / No

I consent for my child’s quotes to be used and published.               Yes / No 

Please after this form has been filled in could you get it to me as soon as possible thank you.