This consent form gives an actor permission to be filmed by four students for their media studies coursework involving the creation of a short film. The form states that the short film will be posted to YouTube once completed and may be viewed by people unknown to the actor, as well as the examiner and media studies teacher. It also notes that the actor can withdraw from the film up until March 1st, 2016, but not after, and that sufficient notice of filming locations and times will be provided. Space is included for listing any food allergies.

1. Actor/Actress Consent Form
I give mypermissiontobe filmedbyKatie Halfyard,LucyClarke,HamzaHanif andEman Shah for
theirA2 MediaStudiescourseworkwhichinvolvesthemcreatingashortfilm.Iunderstandthatthis
short filmwill be postedonYouTube once itisfinished andtherefore people thatIdonot know may
watch it,alongwiththe examinerandSimonAske (TitusSaltSchool’sMediaStudiesteacher).Iam
aware that I can withdrawfromthe filmprocessandask forthe footage notto be used,upuntil 1st
March 2016. I understandthatafterthisdate I will notbe able to withdraw fromthe process,asit
will be tooshortnotice for the productionteam.
I accept that I will needtotravel todifferentlocationsforfilming,butIunderstandthatsufficient
notice will be providedof the date andtime that I needtobe there for.
I have/have notgotany foodallergiesthatwill needtobe takenintoconsiderationwhenthe
productionteamprovide foodondaysof filming.
Please indicate anyfoodallergiesbelow,if relevant:
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Name (printed):
Signature:
Date: