Consent for Use of Photographs in Research

I hereby consent to the use of photographs taken of me in connection with the research project described below. The photographs may be used for the purposes of publication, academic presentation, or educational material as part of this research study.

Title of Research:

Researcher Name:

Participant Name:

Location:

I consent to the use of my photographs as described above in related publications and presentations.

I consent to be identified by name in connection with these photographs.

Notes / Special Instructions:

Participant Signature:

Date:

Researcher Signature:

Date: