I Want You To See Me -- Unlocking Our Stories -- Informed Consent
Completing this form, serves as your informed consent to participate as a STORYTELLER in this project.
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ISSUE BOX THEATRE, PO Box 8623, Toledo, OH 43623

I WANT YOU TO SEE ME: PROJECT INFORMED CONSENT

Thank you for your interest in participating in this project. It is our vision to create a tapestry of lived experiences told through art performances (poetry, song, dance,... or medium you prefer). The culminating performance will be viewed online via Youtube at a date yet to be determined.

Performance Concept:
The performance concept is to amplify voices of marginalized populations - however you may identify. Our vision is to weave together these submissions to create a cohesive, creative piece that will elevate our awareness and education for greater understanding. For the purposes of clarity, you will be granting us permission to amplify your creative expression within a collected set of works. We, in no way, will be “owning” or seeking to “own” your work. 

Performance Delivery:
This performance will be held virtually, therefore, the performance we create will be in video form and shared through a virtual platform (Youtube). We will provide you with a copy of the fully edited segment of your individual work, as it appears within the cohesive presentation. 

Please provide your full/legal name *
ABOUT ISSUE BOX THEATRE *

Our mission statement is to “create space for human dignity using the arts for social justice,”.  IBT hopes to create a production which expresses how participants and communities have been impacted or affected by systematic silencing of experiences and exploitation across marginalized populations. The performance aims to challenge stigma, inspire action, provide a platform, and enhance community for all involved in creating, producing, or witnessing the production. The creation of the production is being overseen by the Board of Trustees for IBT, by our Artistic Director Rosie Best, Co-Director Meg Kraner, and IBT volunteers. For more information about our past work, community involvement, and more, visit our website at www.issueboxtheatre.org

Your Involvement:

Your experience matters. By partnering with the creative tools and artistic experience available through Issue Box Theatre, we want to ensure a collaborative process that enhances your artistic expression. It is our goal that, through amplifying the voices of participants, we may achieve greater consciousness in society about the experience of marginalization that your story tells.

Due to the nature of non-profit work, it is unlikely that you will receive any direct monetary benefit from taking part in this production; however, in alignment with our goal to amplify your voice, you will maintain all intellectual property rights and will own, and be given, the final product of your individual work to use any way you like without having to cover any of the costs of production. This product may also enhance knowledge and inspire change which may help others in the future. 

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Self Care in the Process
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There is no way to predict how any aspect of this process will impact you. For most, involvement in projects like this performance creation is empowering, but there is a risk it could cause emotions that may need guidance. IBT encourages participants to seek out supportive services if needed. Some agencies, in the Lucas County area,  that work directly with the experiences of trauma or marginalized populations are:

A Renewed Mind: https://renewedmindtherapy.com/  (678) 313-0469 

Harbor Behavioral Health: https://harbor.org/  (419) 725-3330 

RFS Behavioral Health:  https://www.rfstackle.com/    (419) 693-9600 

To find support in your area, search for “trauma informed care” or mental health practitioners for specific populations by using https://findtreatment.samhsa.gov/

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Specific Process

If you have a piece that is recorded, and appears as you would like it to be seen, you can submit this to us at seeme@issueboxtheatre.org.

Please, If you prefer to have a conversation with us regarding ways we could enhance the artistic or visual presentation of your art and story, we would be happy to explore this through email or phone/video discussion.

Confidentiality Notice
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During the process, it is important for you to notify us if you would prefer to use a pseudonym to represent your work. Due to this performance being presented virtually, it is possible that this piece will be viewed by individuals from around the world, and we may be unable to track the viewing population. IBT welcomes any questions you may have regarding this process and your rights. It is our priority to uphold transparency in this process. Your participation is voluntary. You may withdraw from participation at any time.  

If you have questions or concerns about your participation in this piece, please contact Artistic Director Rosie Best at 419-508-0797, or rosie@issueboxtheatre.org, Co-Director Meg Kraner at meg@issueboxtheatre.org, or Board of Trustee President Rob Koenig at 419-321-1305 or rkoenig@gmail2844.com

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