ࡱ> ?A>O bjbj .$ee      !!!!4U!i`84l/111111$ V#PU U  j  //W,&k"o0w,$$$ xUU $ : Audio/Video Recording Release Form Instructions for Researcher: Please use this Video Recording Release form if you plan to audio and/or video record participants in your research study. This form may be modified for use in your research project by deleting occasions of future use that do not apply or adding novel occasions of audio and/or video recording not covered here. In all research projects in which you plan to audio and/or video record participants, include information that pertains to the use of audio and/or video recordings for this specific research within the Consent to Participate document (informed consent). Participant Instructions: An audio and/or video recording will be made of you during the research process. The Consent to Participate document describes how your audio and/or video image will be used for this specific study as well as who will have access to your audio and/or video recorded image/voice and where the recordings will be maintained. The researcher would like your permission to use your recorded audio and/or video image for purposes outside of the study. Please indicate below whether you are willing to allow the use of your audio and/or video recorded image/voice for purposes described below. You may request to stop the audio and/or video recording and/or erase any portion of the recording. Please check YES or NO after reading each statement below. Yes No 1. The audio and/or video recording may be shown to participants in other research studies.  FORMCHECKBOX   FORMCHECKBOX  2. The audio and/or video recording may be used for scientific publications and/or presentations.  FORMCHECKBOX   FORMCHECKBOX  3. The audio and/or video recording may be shown in non-scientific publications and/or presentations.  FORMCHECKBOX   FORMCHECKBOX  4. The audio and/or video recording may be shown in classrooms to students.  FORMCHECKBOX   FORMCHECKBOX  5. The audio and/or video recording may be used on television and radio.  FORMCHECKBOX   FORMCHECKBOX  6. Your name may be associated with your image.  FORMCHECKBOX   FORMCHECKBOX  Your signature indicates that you have read and understand the above information, and you have decided how your recorded voice and/or image may be used by the researcher. 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