Consent form — recording and use of my interview

This form is completed in the studio, before the interview, by the person who will be filmed. It explains what we record and lets them decide, line by line, what may be done with it. Each choice is optional. Consent can be withdrawn at any time by writing to bonjour@meromie.com.

Name of the storyteller

Date of the interview

Booked by

My choices

• Private film for my family

  I agree to be filmed and recorded, and to the edited film being delivered to me and to the person who booked, for personal and family use. (Required for the interview to take place.)

• Publication on the Méromie channel

  I agree that my edited film may be published on the Méromie channel (YouTube) and on meromie.com, where anyone can watch it. I understand it may be seen by the public, and that I may ask for it to be removed at any time.

• Short excerpts for presenting Méromie

  I agree that excerpts of my film (up to two minutes in total) may be used to present the Méromie service, on its website and social media.

• First name only

  If my film or excerpts are published, I ask that only my first name be shown.

• I may skip any question, take breaks and end the interview whenever I wish.
• Concia keeps the raw recording for twelve months after delivery, then deletes it, unless I ask otherwise in writing.
• I may withdraw any consent given here at any time by writing to Méromie. Public videos are then removed within ten business days. Copies already delivered to my family are not affected.
• I have read this form, or it has been read to me, and I have had the chance to ask questions.

Signature of the storyteller

Signature of the Méromie team member

Date