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TEMPLATE: INFORMED CONSENT FORM (BENEFICIARY)

TEMPLATE: INFORMED CONSENT FORM (BENEFICIARY)

HUMAN ASSISTANCE FOR DEVELOPMENT INITIATIVE (HADI)
Informed Consent Form – For Program Participation & Use of Image
(To be read out and explained in local language)

Project Title: [Name of Project]
Location: [Village/UC, Rajanpur]

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:

StatementI 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? _________

Consent:
I have heard the information read to me in a language I understand. I have had a chance to ask questions. I voluntarily agree to participate as indicated by my ticks above.

Beneficiary/Guardian Name: ________________________
Signature/Thumbprint: ________________________
Date: ________________________

Witness (HADI Staff): ________________________
Staff Name/Signature: ________________________


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