Photograph/Videotape Addendum to Informed Consent Form

Bryn Mawr College Institutional Review Board

Photograph/Videotape Addendum to Informed Consent Form

[If you are using only photographs, delete the word videotape throughout the form and vice versa. Keep both (video and photographs) if you are using both. If you are requesting consent to use a child’s photograph or video, replace “my participation” to my “child’s participation” throughout.]

In connection with my participation in [NAME OF RESEARCHER]’s research project [NAME OF STUDY], about which I have been informed and to which I have consented in the attached Informed Consent Form, I understand that my [interview/participation in the research] will be [photographed/videotaped, whichever applies]. I understand that I DO NOT need to agree to be [photographed/videotaped] in order to participate in this research. By my signature below, I give my permission for [NAME OF RESEARCHER, or THE INTERVIEWER WHO IS COLLECTING DATA FOR RESEARCHER] to [photograph/videotape] my [interview/participation].

Clause to include parenthetically if videotaping or photographs ARE required: Should you NOT wish to be [photographed/videotaped], please do not sign this form and inform the researcher that you have decided not to participate in this research.

The [photographs/video recordings] will be used for [purpose]. I have been informed that the [photographs/video recordings] will be stored [SECURITY DESCRIPTION—WHERE AND HOW]. I understand that my name may be attached to my responses if they are quoted or summarized in any papers, reports or articles produced from this study. I have been informed that my [photographs/video recordings] may be archived/kept so that future researchers may study them [for x purposes]. [Alternate language: I have been informed that my [photographs/videotaped responses] will be destroyed at the end of this study and no later than [DATE].

By signing below, I also give [NAME] permission to use my [photographs/videotaped responses] in other professional settings, such as university classes or conference presentations to other researchers. I understand that even if my name is not used in connection with these [photographs/video recordings], there is a risk that someone watching the video or viewing the photograph(s) may recognize me. Further, I understand that in the event [NAME] or the College is presented with a subpoena or similar legal requirement requesting my [photographs/videotaped responses], the College will comply with that request.

Please respond to the following:

I AGREE that my name may be attached to my [photographs/video recordings], which may be linked to my responses if those responses are quoted or summarized in any papers, reports or articles produced from this study. Yes ______No______

I have been given a copy of this consent form. Yes______No ______

Name of respondent

Date

Signature of interviewer