Consent Form

Urbanization and Migration in Latin America / Spring 2003

I, _____________________ (please print) understand that my participation in this video/photographic project conducted by X is strictly for educational purposes; and my image, likeness, voice, interview and performance may be used expressly for this project. I do not and will not hold the University of Houston or any members of its staff, faculty or administrators liable in any way in relation to the production of this project. No monies of any type have been exchanged for my agreement to participate in it, and I do not want or expect any payment at any time.

Signature: _____________________________________ Date: ________________

Addition for Minors

I represent that I am the parent and/or guardian of the minor who has signed above or is the participant in the above project. I agree that we both shall be bound by this agreement.

Parent’s/Guardian’s Signature: ____________________________ Date: _______________