Actor/Actress Consent Form

I give my permission to be filmed by Katie Halfyard, Lucy Clarke, Hamza Hanif and Eman Shah for their A2 Media Studies coursework which involves them creating a short film. I understand that this short film will be posted on YouTube once it is finished and therefore people that I do not know may watch it, along with the examiner and Simon Aske (Titus Salt School’s Media Studies teacher). I am aware that I can withdraw from the film process and ask for the footage not to be used, up until 1 st March 2016. I understand that after this date I will not be able to withdraw from the process, as it will be too short notice for the production team.

I accept that I will need to travel to different locations for filming, but I understand that sufficient notice will be provided of the date and time that I need to be there for.

I have/have not got any food allergies that will need to be taken into consideration when the production team provide food on days of filming.

Please indicate any food allergies below, if relevant:

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Name (printed):

Signature:

Date: