Dear………………………………………………

We are writing to ask for your permission containing yourself as a

part of our A Level Media course at Chelmer Valley High School.

The footage will be used as part of our Media course and that only.
It will need to be placed publicly on ‘YouTube’ and will be viewed by
the examiners, our teacher and ourselves.

We guarantee that no information will be issued that could identify

you personally. It’s your decision if you wish to be/ not to be
credited.

Thank you for your co – operation

Matt Thomas and Matt Bigg

A Level Media students
Chelmer Valley High School

Name: __________________________________
Address:
____________________________
____________________________
____________________________
____________________________
____________________________

I give permission for the footage to be used in the above mentioned context.

Your signature: ______________________ Date: ________________

Parent’s signature (if under 18): _______________________________