Video Release Form


The signature below indicates my permission for University Information Technology Services User Experience Group of Indiana University to use video footage recorded during the usability session conducted for


(project) __{project name}___ (date) {month} ________, 200{year},


in which I served as a participant.


My name will not be reported in association with session results nor will my name be included on the video footage. This video footage may be used for the following purposes:


·       Analysis of research and reporting of results

·       Conference presentations

·       Educational presentations

·       Informational presentations


I will be consulted about the use of the video recording for any purpose other than those listed above. 


There is no time-limit on the validity of this release nor is there any geographic specification of where these materials may be distributed.


This release applies to video footage collected as part of the usability session listed on this document only.


I have been given a blank copy of this release form for my records.


Name (please print):



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