Example – Consent for recording, public display
Recording Consent and Release Form
SNC IRB file #: 060706sc
SNC IRB approval date: June 1, 2007
The Acquaintance Process
Type of recording
A video and audio recording will be made of each research session.
Purpose of recording
Observing and taking notes on behavior as it happens is difficult and prone to error. Video and
audio recordings can be slowed, paused, replayed and evaluated by multiple researchers. This
allows researchers to gather more accurate data. Still images and brief video and audio excerpts
can be used to illustrate findings.
Confidentiality
The complete recordings will be kept confidential. Information that could identify you will be kept
separate from the recordings. Complete recordings will be stored securely and only researchers
will have access to the complete recordings. A few still images and brief video and audio
excerpts from some of the research sessions will be retained and used to illustrate findings when
the results of this investigation are reported. When we present still images and brief video and
audio excerpts, we will not include any information that will make it possible to identify the
individuals depicted. The complete recordings will be destroyed (shredded) once the research is
completed.
Permission
I, the undersigned participant, hereby give Chris Smith permission to make a video and audio
recording of my research session. Furthermore, I give Chris Smith specific permission to publish,
copyright, distribute and/or display images (motion and still) of my likeness created as part of the
Acquaintance Process project.
Statement of Consent:
I have read the above information. I have asked the questions I want to ask and those questions
have been answered to my satisfaction. I understand and agree to the conditions outlined in this
recording consent and release form. I hereby allow Chris Smith to use this recording, and I give
up any and all of my own future claims and rights to the use of this recording.
_____________________________
Name of Participant (please print)
_____________________________
Signature of Participant
______________
Date
_____________________________
Signature of Researcher
Chris Smith, Psychology Discipline, St. Norbert College, De Pere, WI 54115
(920) 403 – 4115, chris.smith@snc.edu
______________
Date