Consent and Release Form - Project Dazzle
(Hospital Video Data Collection)
Once you have read this form you can close this window and
return to the Application Form to acknowledge and sign.
Project Contact: Seth Koury at firstname.lastname@example.org
This is a data collection project undertaken by SuperSight Media, Inc. (“us”, “we”, “our”, “Agency”) on behalf of its customer, Appen Butler Hill Inc. (“Appen”). For the purposes of this project we will collect data for the use of Appen and its customer DawnLight Technologies Inc. based in The United States of America ( “Customer”). The Customer is a data controller, and Appen may also be an independent data controller. SuperSight Media Inc. is the data processor. Your decision to participate in this project is completely voluntary and you may decline to participate or request to end your participation in this project at any time by providing us written notice.
By submitting your signature, you are agreeing to provide Appen and Customer with video/image, gender, age range, height, weight, (we call this “Project Data”), and any other information and materials that you provide to us as required under the project (hereinafter referred to as “Materials”) for the project(s) you’ve enrolled in. This Data Collection – Consent and Release (“Consent Form”) is attached to and incorporated by reference into the Master Services Agreement (if any) between you and us. The Materials will be used by Appen and Customer, as defined above, and academics, companies and individuals involved in technology research, development and commercialization, and Customer’s respective customers, vendors, partners and affiliates, as well as our vendors who sub process the Materials (each, a “User” and collectively, the “Users”) to assist in the development and advancement of software, machine learning models, artificial intelligence, algorithms and technology research. Your assistance is much appreciated. For more information on how Appen uses data, please review our privacy policies.
If you wish to withdraw your participation, please contact us at the Project Contact email above. We and the Users may continue to use the Project Data that you provided in accordance with applicable law and our legal obligations. Please note, a request to delete personal information that is already delivered to a User and processed may not be deemed feasible unless required by applicable law. After your withdrawal, we and/or Appen may continue to retain your account information, such as what projects you participated in, for account management and record-keeping purposes.
Processing of Personal Information
We may need to collect, use, and retain personal information from you, or from another entity you provide your personal information to, in order to: execute the project requirements; communicate with you, report to regulatory authorities as required by law; and fulfill any other obligations the we may have to our customers, vendors, or to governmental authorities. Examples of this include but are not limited to your contact information to be able to contact you, your account information and what projects you worked on for our record-keeping purposes, your payment information so we can pay you any owed amounts, other information for fraud detection/prevention purposes. The legal basis for processing your personal information is that it is necessary for the performance of a contract between you and us. You acknowledge and agree to processing and storing of your personal information by us or Appen as necessary to exercise its rights and fulfill its obligations under this Agreement. However, certain special categories of information, such as data concerninghealth or genetic information, biometric data, racial or ethnic origin, religious affiliation or beliefs, political opinions, or sexual orientation, which may be part of the data you submit for the project (but only if the project requires such data), may require your consent before we can process this information. You hereby consent to the collection, processing, and transfer of such special categories of information, and any other project personal information where your consent for processing or transfer is needed under applicable law. Accordingly, you understand that you may withdraw your consent at any time by contacting the Project Contact or if your home jurisdiction entitles you to such rights, by making a data subject access request through the link found on Appen’s homepage at appen.com per Appen’s policies.
Ownership and Use of Materials.
The Materials shall be deemed works made for hire for Appen. Accordingly, Appen shall be considered the author and the owner of the Materials at all stages of completion. All rights (the “Rights”), including but not limited to, all copyrights, and any and all ownership and exploitation rights, in the Materials and the images, video, audio, and other content contained therein, in whatever form in which you appear, are hereby assigned to Appen to use by Appen and its customers throughout the world in all forms of media, forever. If under any applicable law the fact that the Materials are a work made for hire is not effective to place authorship and ownership of the Materials and all rights therein in Appen, then you hereby irrevocably assign and transfer to Appen the Rights, and in connection therewith, any and all right, title and interest you may have in the Materials. Depending on the project description, you may be asked to submit Materials of other individual persons besides yourself. You understand and agree that you will obtain all necessary and valid consents and/or acknowledgments from additional participants before you submit the Materials of other individual persons. The method by which others may register their consent or acknowledgments is specified in the project guidelines and you will strictly comply with such instructions. You herby represent, warrant, and covenant that you have or will obtain all consents, acknowledgments, and assignments as required to provide Appen and the Users with rights necessary to collect, use, store, process, and disclose of each of those individuals’ personal information as described in this Consent Form, including but not limited to, assignment of all of their intellectual property and moral rights as needed in accordance with this Consent Form.
Release of Claims (PLEASE READ CAREFULLY)
TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, YOU, ON BEHALF OF YOURSELF, AND ANY OTHER APPLICABLE INDIVIDUALS, EACH HEREBY WAIVE, RELEASE, DISCHARGE, AND HOLD APPEN, APPEN’S CUSTOMER, AND ANY OTHER USERS HARMLESS FROM LIABILITY BY VIRTUE OF ANY PROCESSING, BLURRING, DISTORTION, ALTERATION, ANNOTATION, MODIFICATION, OPTICAL ILLUSION, OR USE OF THE MATERIALS OR OTHER CONTENT IN COMPOSITE FORM WHETHER INTENTIONAL OR OTHERWISE, THAT MAY OCCUR OR BE PRODUCED WHEN WE, APPEN, OR OTHER USERS USE THE MATERIALS, INCLUDING BUT NOT LIMITED TO ANY CLAIMS FOR INVASION OF PRIVACY, DEFAMATION, AND VIOLATION OF PUBLICITY OR PERSONALITY RIGHTS. YOU UNDERSTAND THAT SUCH ALTERATIONS ARE AN EXPRESS AND INTENDED USE OF THE MATERIALS.
Limitation of Liability. TO THE MAXIMUM EXTENT PERMITTED UNDER APPLICABLE LAW, IN NO EVENT WILL APPEN, ITS CUSTOMER, OR OTHER USERS, BE LIABLE TO YOU OR ANY OTHER INDIVIDUAL PARTICIPATING IN THIS PROJECT FOR ANY INDIRECT, SPECIAL, EXEMPLARY, INCIDENTAL, OR CONSEQUENTIAL DAMAGES (INCLUDING LOSS OF PROFITS OR LOSS OF TIME) ARISING FROM OR RELATING TO THIS AGREEMENT, EVEN IF APPEN, CUSTOMER, OR OTHER USERS KNEW OR SHOULD HAVE KNOWN OF THE POSSIBILITY OF, OR COULD REASONABLY HAVE PREVENTED, SUCH DAMAGES.UNDER NO CIRCUMSTANCES WILL APPEN, APPEN’s CUSTOMER, OR USERS’ TOTAL AGGREGATE LIABILITY OF ALL KINDS ARISING OUT OF OR RELATED TO THIS PROJECT EXCEED THE TOTAL AMOUNT PAID BY AGENCY TO YOU UNDER THIS PROJECT DURING THE TWELVE MONTHS IMMEDIATELY PRECEDING THE CLAIM. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES; THUS, THE ABOVE LIMITATION MAY NOT APPLY IN SUCH JURISDICTIONS.
You acknowledge and agree that Project Data may be transferred to Agency, Appen, to Users, and/or to third parties designated by Appen or Customer, to the United States, Canada, the United Kingdom, the European Union, Australia, Philippines, and other countries, but only for the purposes described herein or in the project description. The transfer of personal information to these entities will abide by the requirements for international data transfers per applicable law. These entities will subscribe to the appropriate legal instruments for the international transfer of data, or will be bound by appropriate contractual arrangements (such as Standard Contractual Clauses, as approved by the European Commission) to protect your personal information. You acknowledge and understand that other countries or jurisdictions may not provide the same level of protections or safeguards for your personal information as that of your home country or jurisdiction.
Your Rights in Project Data
You agree that the Project Data submitted by you are original to and owned by you, or the other authorized data subject(s). By submitting the Project Data, you release Appen, Appen’s Customer, Users, 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 Appen’s use of the Project Data submitted by you. You understand and agree that between Appen and you, Appen is and shall be the exclusive owner of all right, title and interest, including copyright, in the Project Data and any other works that may be created by you containing the Project Data.
-Our Data Protection Officers (DPO’s) can be contacted at email@example.com. You may withdraw your consent by emailing our DPO.
OBLIGATIONS: By agreeing to participate in the project, You acknowledge that any information about the project, including any project details, shall be kept confidential by you and are covered by the obligations under your agreements, including but not limited, to your Master Services Agreement with Appen.
YOU ACKNOWLEDGE THAT YOU HAVE READ THIS CONSENT FORM CAREFULLY, THAT YOU UNDERSTAND AND AGREE TO ALL OF ITS TERMS AND HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS.
Acknowledgment and Consent
I understand that if the legal basis for processing of certain sensitive or special category personal information under this Consent Form is my consent, I can withdraw my consent at any time, but doing so will not affect the processing of such personal information that occurs before my withdrawal of consent.
I acknowledge that the legal basis for processing of personal information (besides sensitive or special category personal information) under this Consent Form may include that the processing is necessary for the performance of a contract between myself and Appen and that processing done on this basis will not be affected by any withdrawal of consent to processing.
Facsimile signatures constitute original signatures for all purposes.
You understand that you may ask for a copy of this Data Collection – Consent and Release Form by emailing the project contact at firstname.lastname@example.org.
Once you have read this form, you may return to the application window to submit your signature along with your application.
One hour video data collection of the participant engaging in physical actions simulating a hospital patient.
WHAT WILL HAPPEN IF I TAKE PART IN THIS PROJECT?
Before you begin the data collection, you will be provided with this Consent Form, which explains what data you will be asked to collect and why. Please review this Consent Form carefully and feel free to ask questions.
A project representative may provide you with additional specifications.
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: full name, email, address, phone number, IP address.
Documented Project Data: photo/video with your image, gender, age range, height, weight.
You should avoid any situations that are sensitive, uncomfortable for any participant, or that elicits information that is unnecessary for this project.
WHO CAN PARTICIPATE IN THIS PROJECT? You must be 18 years old or over to participate in this project.
WHERE WILL THIS PROJECT TAKE PLACE? You will be collecting the data onsite at the Customer’s facilities. No personal information that could uniquely identify you or the other participants (e.g., readable names or addresses) should appear in the collected data. Unless the project instructions say otherwise, no features of other persons (including image or voice) should appear in the collected data. 2.
WHAT RISKS OR DISCOMFORTS SHOULD I EXPECT FROM PARTICIPATING IN THIS PROJECT? This project poses some physical risks and may provide some discomfort associated with certain interpersonal interactions. There may additionally be some unknown and unforeseeable risks. If you feel uncomfortable at any time, contact the Project Contact.
Once you have read this form, you may return to the application window to submit your signature along with your application.