(For more examples of consent forms – for use with minors, recording, etc – see the resources at usability.gov.)
Please read and sign this form.
During this user test I agree to participate in an online session using my computer, including its web camera, microphone, and speakers. During the session I will be interviewed about [gerbils], asked to find information or complete tasks using [your pet gerbil], and asked to complete questions about the experience.
I understand and consent to the use and release of the recording by [full organization name]. (“[organization short name]”). I understand that the information and recording are for research purposes only and that my name and image will not be used for any other purpose. I relinquish any rights to the recording and understand the recording may be copied and used by [organization short name] without further permission.
I understand that participation is voluntary and I agree to immediately raise any concerns I might have.
If you have any questions after today, please contact [your personal name] ([your email address]).
Please sign below to indicate that you have read and understand the information on this form and that any questions you might have about the session have been answered.
Date:
Please print your name:
Please sign your name:
Please include your mailing address (this is where we'll send your compensation):
(Street Address)
(City, State / Region, Postal Code, Country)