Social Awareness Film Participation Consent Form
Please complete this form to provide your consent for participating in our social awareness film project.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please read the following consent statement carefully before agreeing to participate:
I acknowledge that I am voluntarily participating in a social awareness film project. I understand that my image, voice, and statements may be recorded and used in the final production, which may be distributed publicly for educational and awareness purposes. I affirm that I have had the opportunity to ask questions and that my participation is voluntary. I consent to the use of my likeness and contributions as described above.
Signature (Please sign below to confirm your consent)
*
Emergency Contact Name and Phone Number (Optional)
Submit Consent
Submit Consent
Should be Empty: