Sample Interview Release Form
Name of Storyteller: ____________________________________________________
Date/Time/Place of interview: _____________________________________________
Interviewer’s name:_____________________________________________________
Project Name: ________________________________________________________
Contact details (Address/Phone/Email):_______________________________________
Age/Date of Birth: _____________________________________________________
By signing the form below, you give your permission for the interview and/or video and/or audio made during this project to be used for publication purposes including exhibitions, internet, and presentations. Should you have any specific restrictions or agreements, please indicate them below:
I agree to the uses of these materials described above, except for restrictions outlined above.
Name (please print): __________________________________________________
Signature: _________________________________________________________
Date: ____________________________________________________________
Name of Storyteller: ____________________________________________________
Date/Time/Place of interview: _____________________________________________
Interviewer’s name:_____________________________________________________
Project Name: ________________________________________________________
Contact details (Address/Phone/Email):_______________________________________
Age/Date of Birth: _____________________________________________________
By signing the form below, you give your permission for the interview and/or video and/or audio made during this project to be used for publication purposes including exhibitions, internet, and presentations. Should you have any specific restrictions or agreements, please indicate them below:
I agree to the uses of these materials described above, except for restrictions outlined above.
Name (please print): __________________________________________________
Signature: _________________________________________________________
Date: ____________________________________________________________