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PARTICIPANT RELEASE FORM

FOR STUDENT VIDEO

& FILM PRODUCTION

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This section to be completed & signed by interviewee/participant:

Name:.B{-yf{{r LEw.i s..

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I agree to pafticipate in the production named above. The nature and composition of the programme have been explained to me and
recordings made of me, and my contribution, to be edited and used at the discretion of the Producers. Signed:

I hereby give my consent for the voice and/or picture

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