Here's one I've used in the past:[Project Name] InterviewParticipant Consent Agreement I hereby agree that [Company], hereafter referred to as the u201cDesign Teamu201d conducting this Interview may record my appearance and participation for the purpose of [Project Name]. The interviews are part of a study to [brief description of project goals].u00a0u00a0I further understand the following: u00a0Only the Design Team will review the video tapes from the interview.The video tapes will be held by the Design Team and no one else willu00a0 access to the tapes.The video taping can be stopped upon my request at any time for any reason during the interview.My name will not be used in materials presented to anyone outside of the Design Team pertaining to the focus interview session, I will be referred to only by user number.The Design Team will acquire my written consent prior to using any video portion of my focus interview for presentation purposes. I have the right to prohibit such use of my image._________________________________________Dateu00a0_________________________________________Name (print)u00a0_________________________________________Signature