IFD:UXTemplates/DigitalRecordingReleaseForm

Source: usability.gov, released under the public domain

Digital Recording Release Form

I agree to participate in an audio, video, and/or digital recording during the study by the Agency.

I understand and consent to the use and release of the recording by Agency. I understand that the information and recording 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 recording and understand the recording may be duplicated and used by Agency without further permission.

I understand that I can leave at any time.

I agree to immediately raise any concerns or feelings of discomfort with the study administrator.

Your signature:____________________________________________________

Date:______________________________________________________________

Please print your name: ______________________________________________

Thank you!

We appreciate your participation.