Introduction

As a participant in the DARE TO CARE BULLYING PREVENTION program, I agree to the seminar being video recorded for the purpose of teaching and training for new coaches and members joining the UCSC. The video recording will be focused only on the facilitator, Lisa Dixon-Wells.  I am aware that I may withdraw this consent at any time without penalty, at which point, the video recording will be erased. 

By typing my name in the boxes below I consent to organizers of the DARE TO CARE Bullying Prevention Program to videotaping of the session for the purpose of ongoing education and teaching. 

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* 1. Please enter the date.

Date

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* 2. Please type name(s) of Parent/Guardian attendees in the boxes below.

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* 3. I have read and agree to the above statements.  Check 'Yes' if you consent to video recording.  Check 'No' if you do not consent.

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