Autism Awareness Documentary Consent Form
Please complete this form to provide your consent and participation preferences for the Autism Awareness Documentary.
Participant Full Name
*
First Name
Last Name
Are you the participant or a parent/guardian?
*
I am the participant
I am the parent or legal guardian
Parent/Guardian Full Name (if applicable)
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
Email
Phone
Participation Preference
*
I agree to participate and be filmed/interviewed
I agree to participate but do not wish to appear on camera
I do not wish to participate
If you have specific preferences or limitations regarding your participation, please describe them here.
Signature
*
Submit Consent
Submit Consent
Should be Empty: