PARTICIPANT RELEASE FORM

FOR STUDENT VIDEO and PHOTOGRAPHY PRODUCTION

Title (working or provisional): Daylily

Name/s of producer/s: Benjamin Hollis

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

Name: ELENA
I agree to participate in the production named above. The nature and
composition of the video/photoshoot 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. I acknowledge that by signing this form I give up all claims of
ownership, income, editorial control and use of the resulting voice and/or
picture recordings and assign all copyright ownership to the Producer.

Signed:

Date: 19/10/21