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Test Participant Videotape Release Form I agree to participate in the study being run and videotaped by the (agency/instition). I understand and consent to the use and release of the videotape by the (agency/instition). I understand that the information and videotape is for research purposes only and that my name and image will not be used for any other purpose. I relinquish any rights to the videotape and understand the videotape may be copied and used by the (agency/instition) without further permission. I understand that I can leave at any time. I agree to immediately raise any concerns or areas of discomfort with the study administrator.
Your Signature: ________________________________________ Date: ________________________________________________ Please print your name: _________________________________
Thanks! We appreciate your participation.
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