SayPro Storytelling Consent Form

1. Participant Information

• Full Name:
• Age:
• Gender:
• Location:

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2. Description of Story/Content

Please briefly describe the story, interview, photos, or other materials to be used:

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3. Purpose of Use

The information, images, and quotes you provide will be used by SayPro for the following purposes (check all that apply):

• Program reports and evaluations
• Newsletters and publications
• Website and social media
• Training and learning materials
• Fundraising and donor communications
• Other (please specify): ___________________________

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4. Consent

By signing below, I:

• Give permission to SayPro to use my story, images, and/or quotes as described above.
• Understand that my information may be shared publicly in print and digital formats.
• Confirm that I have not been coerced or pressured to provide this consent.
• Understand that I can withdraw my consent at any time by contacting SayPro at mel@saypro.org.

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5. Privacy & Confidentiality

• My personal details will be kept confidential unless I agree to be identified by name.
• If requested, my name will not be used, and pseudonyms or anonymity will be respected.

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6. Signature

• Participant’s Signature:
• Date:
• If under 18, Guardian’s Name and Signature:
  Name: __________________________
  Signature: ______________________
  Date: ___________________________

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7. SayPro Representative

• Name:
• Role:
• Signature:
• Date:

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Notes:

• This form will be securely stored and used only for the stated purposes.
• Participants have the right to review and approve materials before publication if requested.