PARTICIPANT RELEASE FORM FOR STUDENT VIDEO & FILM PRODUCTION Programme Title (working or provisiona):A2 Music Video Filming Name/s of producer/s: Gabrielle Dixon This section to be completed & signed by interviewee/participant: name: CHARLOTTE... BAR NARIO......corin 1 agree to participate in the production named above. The nature and composition of the programme have been explained to me and I hereby give my consent for the voice and/or picture recordings made of me, and my contribution, to be edited and used at the discretion of the Producers. Signed: tht ; Contact Address: osname unn mnie Telephone: Q) a i 1" Citopec. 204 Date: CHALLENGING MINDS. NSPIRINGSUCCESS.- NORWICH