Records Release Consent Form
----------------------------

As part of a student project on XXX, we are making a photographic,
video and/or audio recording of your actions during this study.  We
would like you to indicate below what uses of these records you are
willing to consent to.  This is completely up to you.  We will only
use the records in ways that you agree to.  In any such use of these
records, your name will not be identified.


Please initial all those statements that you agree to.

The records can be studied by the student team for use in reports.	_____

The records can be shown to subjects in other experiments.		_____

The records can be used in scientific publications.			_____

The records can be shown at meetings of scientists interested in the
study of human-computer interaction (HCI) and information access.	_____

The records can be shown in presentations to the public. 	  	_____


I have read the description and give my consent for the use of the
records as indicated above.

Name (printed):		______________________________

Signature: 		______________________________

Date:			______________________________