Consent form for video recording for teaching and learning purposes

Place of video recording: _____________________

Date of video recording: _____________________

Interviewee’s name: ______________________________

Interviewers name: __________________________

Camera Person’s Name: __________________________________

___________________________________________________________________________

We will be making a video recording of some or all of your interview with

Natasha Jones. The interview is for the purpose of acting as evidence for a dissertation about how the
portrayal of females has changed in video games.

The video is only of you and the interviewer talking together. Upon request faces can be blurred out
and a different name (eg badge name) could be used if requested. Only people over the age of 18 will
be interviewed.

Only the interviewer and the college tutor will see the finished video interview. The memory card will
not be copied to a computer. Any information on the memory card will be erased upon completion of
the course.

If you consent to your interview being recorded, please sign below.

____________________________________________________________________

TO BE COMPLETED BY THE INTERVIEWEE

I have read and understood the above information and give my permission for my interview to be
video recorded.

___________________________________________ Date _________________________

Signature of interviewee BEFORE interview

After seeing the doctor I am still willing/I no longer wish [delete as appropriate] my interview to be
used for the above purposes.

___________________________________________ Date _________________________

Signature of interviewee AFTER interview