actor consent form

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:
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………...
Name (printed):
Signature:
Date: