Consent Form For Cast Respondant

We created a consent form for the actors appearing in our film so that they know exactly what we are doing, and what their footage would be used for and shown to. For us to film them, we have to have written consent from them.


Chelmer Valley High School Media A Level Class.


Dear Respondent,


We are writing to request your permission to use footage containing yourself as part of our A Level Media Course at Chelmer Valley High School.

The footage will be used as part of our Media coursework, and will therefore be placed on ‘You Tube’, our Blogs and viewed by the examiners, teachers and ourselves.

We guarantee that no personal information will be shown, so your identity will remain personal, and it is your choice whether to be/not to be credited.

Thank you for your time and co-operation.


Jo Roberts, Rosiee Fenner, Emmaline Gordon and Lucy Clark
A Level Media Students.
Chelmer Valley high School




Name: _______________________________ D.O.B: ___/___/_____

Address: ________________________________________________

_________________________________________________

I give permission for the footage of myself to be used in the context as mentioned above.

Signature: _____________________________ Date: ________________



If you are under the age of 18, or will be for the duration of the filming (January 2010), please turn over.