Informed Consent Form

Hello! Thank you for your participation and contribution in [NAME OF THE ACTIVITY], organized by [ORGANIZER].

We acknowledge that your data has direct relevance to your dignity, autonomy, and bodily integrity. We want to be very transparent and respectful with regard to how we will handle the materials, and under which conditions they will be made public.

We want to remind you that your participation in this process is voluntary. We seek only to get the materials that you are willing to provide consent for and to use them under the conditions you will list below. Remember that you have the right to withdraw even after the materials have been published on Wikimedia Commons or social media platforms.

If at any point you have doubts or concerns of any kind about how your data will be handled, or you encounter something you don’t like in the process, please feel free to reach out to: [Contact email]

Before you can give your consent, please take a few moments to read the information below:

As the person portrayed in the material, you have personality rights that govern the taking, hosting, and use of photographs: the right to publicity (control of the commercial use of your material), and the right to privacy.
Even if you are the person appearing in the material, the person who created the artwork owns the copyright of the material.
The material will be published on Wikimedia Commons under the Creative Commons Attribution-ShareAlike 4.0 International license. This license allows anyone to access and use the materials, including for commercial use and modification.
The photographs may also be posted on social media platforms.
Once we publish the pictures online, people may use them in different ways, for example, they may appear on other websites and publications without needing further permission from [ORGANIZER], the creator, or you.
Please note that you can exercise your right to withdraw the use of your data/photo anytime from our social media accounts, and Wikimedia Commons (if applicable) by contacting: [CONTACT EMAIL]

I, (name OR pseudonym) __________________________________________________________________, give my consent for participation and use of the following material

[ADD OR REMOVE ITEMS AS NEEDED IN THE CONTEXT OF YOUR ACTIVITY]:

Photographs
Illustrations or other forms of art representation
Quotes
Recordings

for the [NAME OF THE ACTIVITY].

1. I agree to allow the created material to be used as follows:

Shared on [ORGANIZER] social media;
Shared on Wikimedia Commons, the free multimedia library of Wikipedia;
Without publishing, and only for internal documentation purposes by [ORGANIZER]

2. I provide this consent of participation and use of materials as stated above, under the following conditions:

Material is produced in group setting (e.g. group photos)
Material is produced in individual setting (e.g. standalone portrait)
Material is used with respect to my privacy protection where the following identifying information has been changed:
- pseudonym (print): ___________________________________________;
- voice change;
- appearance change;
- people mentioned;
- other:
Other specific conditions:

__________________________ _________________________

Name / chosen name / pseudonym Place and date

How do you want to share your personal information?

Do you want your name, or some information about you, to appear when we publish your photo? We are committed to respect your privacy/anonymity. We undertake, to the best of our ability, to remove/anonymize your personal information at your request in the future, in order to keep you safe.

Yes
No

If you say yes to the above, tell us what you want us to share about you. It can be all, or just some of these things:

Your name, nickname, social media handles, or whatever you want us to mention about you.

The way you expect other people to refer to you (preferred pronouns).

Where are you from?

Anything else you want to share about yourself or your work?

How can we send you your photo and other materials after the event?