Consent and Release Form
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return to the Application Form to acknowledge and sign.
INFORMED CONSENT AND RELEASE
Project Title: Project Mumbo – Video Data Collection
Project Lead: Kristy Mueller –
This is a data collection project undertaken by APPEN BUTLER HILL PTY LTD
(“Company”). Your decision to participate in this project is completely
voluntary and not a requirement or expectation of your job. If you decide to
participate, it should be during your personal time. You may decline to
participate or stop your participation at any time. The results of this study may
be used to develop and improve products and services, such as technologies and
algorithms that operate on images, video, and/or depth data. These could include
machine learning, algorithms and other technologies for focusing, color, contrast,
classification and recognition, image processing, and immersive multi-media.
PROJECT SPECIFIC DETAILS
WHY IS THIS PROJECT BEING DONE?
The purpose of this study is to collect videos of people within the context of their environment (“Project Data”).
WHAT WILL HAPPEN IF I TAKE PART IN THIS RESEARCH PROJECT?
Intake / Receipt of Instructions (5-10 minutes):
• Before you begin your data collection, you will be provided with this Consent
and Release Form or “Consent”, which explains what data you will be asked
to collect and why. Please review this Consent and Release Form carefully
and feel free to ask questions.
• A representative from the Company may provide you with additional
instructions regarding what documents and/or objects to collect and how to
capture the video of that document and/or object and provide it to
Video Capture (1.5 to 2 minutes):
• You will be asked to perform a minimum of 1 to a maximum of 4 selfie videos emulating a Facetime conversation (each 1.5 – 2 minutes long) in different environments (indoors, outdoors) at different times of the day (morning, afternoon, evening and night)
WHERE WILL THIS PROJECT TAKE PLACE?
You can record the video in any setting in which you feel comfortable, so long as the
video only captures you participating in the activity, per the
directions you receive. No features of other persons (including image)
should appear in the video. Other than your own facial features, no personal
information that could identify you or the other participants (eg readable address or
name) should appear in the video.
HOW LONG WILL MY PARTICIPATION IN THIS PROJECT TAKE?
This project should generally take you between 10 - 15 minutes, depending on
the number of tasks you perform.
WHO CAN PARTICIPATE IN THIS PROJECT?
You must be 18 years old or over to participate in this project. If an individual under
the age of 18 years old is participating in this project, written consent from the
individual’s parent/legal guardian must be obtained.
WHAT DATA WILL BE COLLECTED?
As part of this project, the information collected from you may include the following
(we call this “Project Data”):
· Contact Information: Worker ID (anonymous randomly assigned ID unique to each
· Video: Video of your head, neck and shoulders
· Documented Project Data: Gender, Birth Year, Race/Ethnicity and Skin Color
PROJECT DATA AND PERSONAL INFORMATION
Project Data may reflect the image, likeness, voice, and other general characteristics
of you and others. By signing this Consent, you agree to allow Company and external
entities that Company chooses to collaborate with (subject to appropriate
contractual obligations) to collect, use, store, process, and disclose your personal
information for the purposes described in this Consent and in connection with the
project. If you are the parent/legal guardian of a person under the age of 18 years
old who is participating in this project, you agree to allow Company and external
entities that Company chooses to collaborate with to collect, use, store, process, and
disclosure the minor’s personal information for the purposes described in this
Consent and Release and in connection with this project. To the extent that you
provide Company with the personal information of other persons in connection
with your participation in the project, you represent that you will obtain all consents
required to provide Company with the rights necessary to collect, use, store, process,
and disclose their personal information as described in this Consent.
YOUR RIGHTS IN PERSONAL INFORMATION
Company is collecting Project Data on behalf of the Study Sponsor. Company may
disclose Project Data to the Study Sponsor for use consistent with this Consent and
Release Form. The Study Sponsor and Company may retain third parties to collect,
process, and analyze the data on their behalf. Study Sponsor may retain deidentified
data, analysis, models, algorithms, learning and work product obtained,
trained on, or otherwise resulting from use of Project Data.
If you decide to participate, you have the right to request access to Project Data and
the right to request to have any such data rectified, completed, blocked or deleted.
You also have the right to subsequently object to the collection of any such data and
revoke your consent at any time. Please submit such a request or revoke your
consent through your Project Lead. Your request will then be passed on to the Study
If you decide to participate in the project, you have the right to access any data
collected about you as part of this project and the right to have any such data
corrected, completed, blocked or deleted. You also have the right to object to the
collection of any data and withdraw from the project at any time. To exercise any of
your rights or to raise questions on the use of your data within this project contact
the Project Lead.
You represent that the Project Data videos submitted by you are original to and
owned by you, if applicable, and that you have full authority from any individuals
depicted in the Project Data videos to provide them to Company pursuant to the
terms of this Consent. You agree to release Company, its agents, employees,
licensees and assigns from any and all claims you may have now or in the future for
invasion of privacy, right of publicity, trademark infringement, copyright
infringement, defamation or any other cause of action arising out of Company’s use
of the Project Data videos submitted by you. You understand and agree that
between Company and you, Company is and shall be the exclusive owner of all right,
title and interest, including copyright, in any works that may be created by Company
containing the Project Data, subject to pre-existing rights in any of the Project Data.
USE, DISCLOSURE, AND DELETION
Any information that you provide to Company in connection with the project,
including the Project Data, will be kept Confidential. The Project Data may be used
by Company, Study Sponsor, their personnel, and third party vendors or business
partners subject to appropriate contractual obligations, for the purposes described
in this Consent. Project Data may also be provided to public, regulatory, or
government authorities, including law enforcement, when required by law, legal
process, or litigation.
Any Project Data containing personally identifiable information, including
identifiable image or voice data, that you provide to Company in connection with the
project, will be deleted will be deleted within 10 years of the date of this Consent
and Release. Project Data that does not contain personally identifiable information,
including where such information has been blurred or similar, may be continued to
be retained. You may contact the Project Lead at any time to request deletion of
your personal information and reasonable efforts will be made to delete your
personal information within a reasonable amount of time; however, note that in
some circumstances, deletion of your personal information may not be feasible.
WHAT RISKS OR DISCOMFORTS SHOULD I EXPECT FROM PARTICIPATING IN
This project does not pose any known risks. There may additionally be some
unknown and unforeseeable risks.
WITHDRAWAL: You may decline to participate or stop Your participation in the
project at any time by providing written notice to the Project Lead. Company may
continue to use the videos that you provided to Company prior to your withdrawal
unless you request that it be deleted as described above, in which case it will be
deleted where feasible.
By agreeing to participate in the project, you acknowledge that any information
about the project, including any project details or the fact of your participation, are
considered Confidential Information and are covered by the obligations under your
agreements with Company.
What are My Confidentiality Obligations?
If you agree to participate in the study, you must also agree to not disclose any
information from or about the study with anyone, without first obtaining approval
from the Project Lead.
What is Considered Confidential?
The fact that the Company is conducting this study, the types and methods of data
collection, and any other detail about the study or how it is conducted are
confidential. Any information that you learn about the study, including technical
information and the identity of the personnel in the study or working on the study,
and any other information identified as non-public information is considered
confidential and proprietary information that belongs to the Company or Study
Sponsor and must not be disclosed by you. This includes before, during, and after
you participate in this study. You may not use any cameras, video recorders or other
electronic storage devices to record Confidential Information at any time.
Who Needs to Know?
Do not assume that anyone, including other Company employees, knows
information about the study. Most Company employees do not know about this
study. Do not talk to anyone about the study unless you are authorized in writing to
do so by the Project Lead. It is of utmost importance that no confidential
information be communicated to anyone, in any manner, outside of Company, study
personnel or Project Lead, including friends, family members, professional
colleagues, and especially, the press. You may not discuss or display any
Confidential Information in any form, including via phone, electronic
communications or social media.
Take Precautions To Avoid Inadvertent Disclosure.
You will not be permitted to take any photographs or videotape anything related to
the research study. When communicating with the study personnel, make sure you
are in a private location.
Failure to maintain the confidentiality of information may seriously harm the study.
If you become aware of any unauthorized disclosure of confidential information,
please report it to study personnel or Project Lead immediately.
If you have any questions that are not addressed here, please discuss with study
personnel or Project Lead.
What are Company’s Enforcement Rights?
You hereby acknowledge that unauthorized disclosure or use of Company
Confidential Information could cause irreparable harm and significant injury to
Company that may be difficult to ascertain. Accordingly, you agree that Company
will have the right to seek and obtain immediate injunctive relief to enforce the
confidentiality obligations under this Consent and Release, in addition to any other
rights and remedies Company may have.
STATEMENT OF CONSENT
Your signature on the main application form is your acknowledgement of the following:
• I have read and understand this Consent and have received answers to my
• I am voluntarily signing this Consent indicating that I consent to participate
in this study.
• I agree that I will keep confidential all information disclosed to me during the
• I grant Company and the Study Sponsor the right to collect, use, process,
store, and disclose Project Data as described in this Consent.
• I understand that I can receive a copy of this Consent form upon request.
WHO CAN ANSWER MY QUESTIONS ABOUT THE PROJECT?
If a project-related problem should occur, or if you have any questions about the
project at any time, please contact the Project Lead listed above.
CONSENT AND RELEASE
You acknowledge that you have read this consent carefully, that you understand and
agree to all of its terms.
You understand that you may ask for a copy of this Informed Consent and Release
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