[Name of child], who is under my care and control has been asked to take part in the above workshop and production of a film.

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1. That on signing this I have agreed that all or some of [name of child]’s recorded contribution can be included in this film and to the other points in this letter.

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2. That the nature of the film which deals with creativity and the invention of alternative realities and histories.

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3. That the artist does not have to use [name of child]’s recorded contribution, but if they do, they may fairly cut and edit it as the artist wishes and use it in any publicity for the film.

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4. That I give all necessary consents for [name of child]’s recorded contribution to be used in all media anywhere in the world.