SayPro Ethical Storytelling Consent Form

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1. Participant Information

• Full Name:
• Age:
• Gender:
• Contact Information (Phone/Email):
• Location:

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2. Story / Visual Description

• Brief description of the story, interview, photo, video, or other content to be collected and shared:

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3. Purpose and Use

I understand that the story and/or images I provide will be used by SayPro Magazine and its Strategic Partnerships Office for the purposes of:

• Awareness raising
• Advocacy
• Publication in SayPro Monthly Magazine and related media
• Educational and promotional materials

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4. Consent

By signing below, I consent to the following (please check all that apply):
☐ My story and/or images may be used in print and digital formats by SayPro.
☐ I understand that my identity may be revealed unless otherwise requested.
☐ I request anonymity and understand that SayPro will take reasonable steps to protect my identity.
☐ I consent to the use of my real name/identity.
☐ I have been informed that I can withdraw my consent at any time before publication by contacting SayPro.
☐ I confirm that I have shared this story voluntarily and that all information provided is accurate to the best of my knowledge.

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5. Risks and Confidentiality

• I understand the potential risks involved in sharing my story or image, including privacy risks.
• SayPro will handle my information with confidentiality and respect, according to its ethical standards.

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6. Participant’s Declaration

I have read and understood this consent form, and I agree to participate voluntarily.

• Participant Name:
• Signature (or typed name):
• Date:

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7. Representative/Guardian Consent (if participant is under 18 or requires a guardian)

• Guardian Name:
• Relationship to Participant:
• Signature:
• Date:

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8. SayPro Representative

• Name:
• Role:
• Signature:
• Date: