Video consent and release form         
                 
             

       
            The following is a standard video consent and release form. It may 
            be adapted to fit local requirements.

            Video Consent and Release
            I hereby consent to the use and publication by the Population 
            Council, Inc. of video images of me and to the Population Council’s 
            use of my image on a video intended for media dissemination  and 
            viewing at conferences and on the Internet.  I agree that all such 
            video images, and all rights therein, which include all worldwide 
            copyrights, shall be and remain the Population Council’s sole and 
            exclusive property. This consent is irrevocable.
            I hereby release and discharge the Population Council, Inc. from any 
            and all claims and demands arising out of or in connection with the 
            use of such video images, including but not limited to any claims 
            for defamation or invasion of privacy.
            I am of legal age and have read the foregoing and fully understand 
            the content thereof.
             
            Signature:_________________________________________________________________________________ 

            Date:_____________________________________________________________________________________ 

            Witness:__________________________________________________________________________________ 

             
             
            Videographer: 
            _____________________________________________________________________________ 

            Description of Footage:   
            _________________________________________________________________________________________ 

             
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