Jamilla Dumbuya Drapers Academy Settle Rd, Romford, Greater London RM3 9XR P RS!

"AL APP ARA"# Production Date(s): Program Title (working title): The Agony of A-Levels Participant s !ame: Producer"Production #ntity: $amilla Dum%uya (&Producer') Production Location: Drapers Academy ( here%y authori)e Producer to record and edit into the Program and related materials my name* likeness* image* voice and participation in and performance on film* tape or otherwise for use in the a%ove Program or parts thereof (the &+ecordings'), ( agree that the Program may %e edited and otherwise altered at the sole discretion of the Producer and used in whole or in part for any and all %roadcasting* non-%roadcasting* audio"visual* and"or e-hi%ition purposes in any manner or media* in perpetuity* throughout the world, Producer may use and authori)e others to use all or parts of the +ecordings, Producer* its successors and assigns shall own all right* title and interest* including copyright* in and to the Program* including the +ecordings* to %e used and disposed of without limitation as Producer shall in its sole discretion determine, #ontacts and $uestions% At this time you may ask any .uestions you have regarding this production, (f any .uestions arise later you may contact $amilla Dum%uya at $amilladum%uya/hotmail,co,uk, Statement of consent% ( have read and understood the a%ove information, ( have asked any .uestions ( had regarding the filming process and they have %een answered to my satisfaction, ( give consent to participate in this production, 0ignature of Person Appearing: Date: R L AS form template