Consent Form Thank you for participating in this project. Please read and check the boxes to confirm you have understood and agree to the following: I grant Lottie Stevenson the right to use my photograph, audio recording, video recording, or any reproduction or modification thereof (the “Photograph,” “Audio,” and/or “Video”), in any manner or medium throughout the world an unlimited number of times in perpetuity in advertising, trade, promotion, exhibition, or any other lawful purpose. This may include but is not limited to broadcast, print, online, and social media. I understand that the images and audio captured are the copyright of Lottie Stevenson. Any other intellectual property which arises in the recordings also belong to Lottie Stevenson. I understand that my image and / or contribution may be edited, adapted, or translated. I understand that I will not receive any money for the permissions I am granting. I waive any right of inspection or approval. I understand Lottie Stevenson will rely on this permission and release and discharge her from any liability, claims, demands, damages or expenses arising out of or in connection with the media or the exercise of the permissions granted here, including but not limited to, breaches of data protection, defamation, invasion of privacy, or emotional distress. I can request for my media to stop being used at any time, in which case it will not be used in future but may continue to appear in publications, exhibitions, or on online platforms where it has already published. Name * First Name Last Name Phone number * (###) ### #### Email * Thank you!
