TEMPLATE: INFORMED CONSENT FORM (BENEFICIARY)
1. Introduction: My name is ________ from HADI. We are implementing a project about [briefly describe project]. We invite you to participate.
2. What your participation involves: [Describe activities, time commitment, any risks/benefits].
3. Voluntary Participation: Your participation is voluntary. You can say no, or stop at any time, without any negative consequences to the assistance you receive from HADI or others.
4. Confidentiality: Any personal information you share will be kept private and secure. Your name will not be linked to reports without your permission.
5. Use of Photographs/Videos:
We would like to take photographs/videos for project records, reports to donors, and to show our work to others.
These images will be used respectfully, never to humiliate or stigmatize.
You can agree to be in photos/videos, or you can refuse. Your decision will not affect your participation in the project.
Please tick your choice below:
| Statement | I AGREE ✓ | I DO NOT AGREE ✓ |
|---|---|---|
| I agree to participate in the project activities. | ||
| I agree that HADI can take my photograph/video. | ||
| I agree that HADI can use my photograph/video in its reports, website, and social media to show its work. |
6. Questions: Do you have any questions? _________
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