PARTICIPANT RELEASE FORM FOR STUDENT VIDEO & FILM PRODUCTION Programme Title (working or provisional):A2 Music Video Filming Name/s of producer/s: Gabrielle Dixon This section to be completed & signed by interviewee/participant: TRAVIS LOR EINS I agree to participate in the production named above. The nature and composition of the programme have been explained to me and Thereby give my consent for the voice and/or picture recordings made of me, and my contribution, to be edited and used at the discretion of the Producers. Name: (print) Signed: FLY KIS Contact Address: ...2. Telephone: ...2.7 pate: LLL LI nae ILLEGE omy co CHALLENGING MINDS. INSPIRING SUCCESS. NORWICH