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Click ‘Get Form’ to open it in the editor.
Begin by filling in the legal entity or organization name where indicated. This identifies who will be using your image and likeness.
Review the permissions listed and initial next to each applicable option: (a) for video reproduction, (b) for using your name, and (c) for quotes from interviews.
Provide your full name, signature, address, and date at the bottom of the form to confirm your consent.
If you are signing on behalf of a minor, ensure that you complete the section for parent or legal guardian's signature and print name.
If required, have an organizational representative read the consent form aloud to you and sign where indicated.
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Example: All information taken from the study will be coded to protect each subjects name. No names or other identifying information will be used when discussing or reporting data. The investigator(s) will safely keep all files and data collected in a secured locked cabinet in the principal investigators office.
What is an example of an informed consent statement?
Some of the crucial information in a release includes: Name of the parties involved, i.e., releasor and releasee. Detailed information about the project. Explicit information of the permissions granted. Any special considerations, including payment obligations or credit, if any. A space for all parties to sign.
What is a good example of informed consent?
Instructions for Developing an Informed Consent Document General Information. Describe the purpose(s) of this research study in lay terms. Purpose of the Study. Procedures. Risks. Benefits. Compensation, Costs and Reimbursement. Withdrawal or Termination from Study. Confidentiality.
2017 video consent release form template
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2017 video consent form blank
MINOR CONSENT TO MEDICAL TREATMENT LAWS
This compilation includes state, District of Columbia, and territory statutes as of January 2013 regarding minor consent laws to medical treatment.
Having been fully informed of the subject matter of this film entitled (TITLE) and its intended distribution, and without expectation of compensation or
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