1 Billion Rising Video

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Consent form for participation in video 2021

Please fill out a separate form for each individual submitting a video

First Name *

Surname *

Age *

18+

Under 18

Required

First name and surname of person appearing in the video if under 18

Would you like your name OR social media handle (personal or professional) to appear on the video/credits? *

Yes

Required

If you would like your name OR social media handle to appear on the video/credits, please write below how you would like it to appear

Method of video submission *

Email (including file sharing services such as wetransfer)

Facebook messenger

Instagram Messenger

Required

I am providing the video of myself freely, for not-for-profit use by ZoCo Wellness as part of the One Billion Rising Campaign Video. I understand that I may not appear in the final video. I understand that the final video will be published online and has the capacity to be shared across the internet. *

I consent to the use of my video as outlined above

I consent to the use of my child's video as outlined above (for under 18s)

Required

Date of consent submission *

YYYY

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