PHOTO, AUDIO AND VIDEO CONSENT FORM

I, the undersigned
full name______________________________________________________________________________,
domiciled at ___________________________________________________________________________,
personal address________________________________________________________________________,

1 / attest not to be bound with a third party by a contract of exclusivity on my image or voice.

2/ hereby acknowledge that I will be photographed, recorded, or filmed during IDAI 2021 Summer School.

3/ authorize the use and provision of these photographs, recordings and videos by DFKI in digital form, with the purpose of making
them available to the participants in the aftermath via the IDAI 2021 Summer School Microsoft Teams repository.

The images and voices stored in the IDAI 2021 Summer School Microsoft Teams repository of DFKI, will be kept as long as they are
relevant with the maximum period set as 1 year.

4/ understand that I can exercise the access, rectification, erasure, restriction, objection and portability rights (as described in
articles 15 to 20 of the GDPR) and I may revoke this authorization by notifying DFKI (the data controller) at any time. The revocation
will not affect any actions taken before the receipt of this written notification.

5/ understand that I can lodge a complaint with a supervisory authority.

6/ noted that any use or dissemination of my image or voice by DFKI, other than those provided in this authorization, must first
receive my consent.
I acknowledge that the fixation, use and dissemination of my image or voice under the conditions specified above are not likely to
affect my privacy, integrity and reputation.
This authorization is given, to the exclusion of any commercial activity, free of charge, for the whole world and for a period of a
maximum of 1 year as of this day.
The data controller is

Deutsches Forschungszentrum für Künstliche Intelligenz GmbH (DFKI)

Trippstadter Strasse 122, 67663 Kaiserslautern, Germany
Site: DFKI Saarbrücken, Stuhlsatzenhausweg 3, Saarland Informatics Campus, bldg D 3_2, D-66123 Saarbruecken, Germany
Contact point: idessai-support@dfki.de
The contact information of the data protection officer is: datenschutz@dfki.de

By signing below, I indicate my consent according to Art. 6 Par. 1 Point (f) EU-GDPR:

Name: _____________________________________ E-mail: ________________________________________

Signature ___________________________________________________________ Date __________________