DOCUMENTARY-MAKING
“Make your own short film!”
Parental Consent to Form for youth program participants
I give my permission for ______(name of participant) to participate in the "Make your own short film" Program.
I understand that this will entail a 5-day program that will include instruction on how to create a short documentary film. I also understand that the program's aims are to assist the girls' to:
a)To explore issues of identity
b)To learn about the technical aspects of creating a documentary
c)To create a short documentary film
I give my permission to Anti-dote: Multi-racial Girls and Women’s Network, and all persons authorized by or claiming through or under it to:
1)Supervise, train, and otherwise carry out all activities related to the program
2)Follow program policy and procedure in the event of any emergency involving my child
3)Ensure adherence of youth to all program policies and procedures
Date ______
Parent/Guardian Name (print)______
Phone # ______Email ______
Address ______Postal code ______
Parent/Guardian Signature ______
Please drop off completed consent forms at the Vic West YMCA - 521 Craigflower Rd between 9am-6pm. Forms and feesare due by August 1st, 2005. Cheques are payable to Antidote: Multiracial Girls’ and Women’s Network. The cost of this program is $150.00. For more information about Registration or Financial Assistance, contact April Williams by phone: 727-0988 or email:
Should you have any questions about the above, please contact the Executive Director: Winnie Chow (250) 383-5144 Box 3138 or email
DOCUMENTARY-MAKING
“Make your own short film!”
Image Release Form for photos taken of/by participants
I give my permission to ______(name of participant) and to Anti-dote: Multi-racial Girls’ and Women’s Network, and all persons authorized by or claiming through or under it to:
1)Make copies of my image in photographs, videos, printed matter and on the project website for promotional purposes;
2)Publish, exhibit, play, transfer, post on project web-site and otherwise use my image, photographs, video recordings and any copies so made, or any part therefore, and;
3)Use my image(s) for the purposes of promotion and dissemination of project such as on the project web-site and in presentations.
I understand that the photographs will become property of Anti-dote and the participant should the participant wish to retain copies.
Date ______
Parent/Guardian Name (print) ______
Parent/Guardian Signature ______
Should you have any questions about the above, please contact the Executive Director: Winnie Chow (250) 383-5144 Box # 3138 or email