Consent Form

Dear Respondent,


We are looking for someone to play certain roles in our A-Level media film and we need footage of people that we can use and work with.

The footage will be made public for people to watch on “youtube” and also for it to be marked later on in the year by examiners.

You need to be aged 16 or over to be used for our piece, if you are under 16 let us know immediately but you can consent yourself.

Because of legal reasons, if you are under the age of 18 you also need parental consent to be given.

There will be no information about you that can be found by anyone apart from us and everything will be confidential. If you wish to be discredited from this, please let us know as soon as possible.

Thank you for all your help and co-operation.

I understand that I have given permission to be filmed and used for the above project. By giving consent, I know that this footage can be used in any public environment and seen by anyone.

I ……………………………………………………………………… [Insert full name]
Of……………………………………………………………………………………………………………………………………………………………………………………………… [Insert full address]
Age: _______
Signed: ____________________________
Date: _________


I give permission for the above student to be used in the above context.
Signed by student: _______________________
Signed by Parent: ________________________
Date: _________


Sophie Tindall, Hazel Clifton and Jo Peplow-Revell
A Level Media Students
Chelmer Valley High School



This is our consent form that will be used for our auditions and then our chosen actors. This will go home with the students with a school letter.
Sophie wrote the consent form.