'BUILD POSITIVE CHANGE' CONSENT FORM
I hereby authorise the Producer Belfast Bohemian Productions to record and edit into the Build Positive Change Project and related materials my name, likeness, image, voice and participation in the project, tape or otherwise for use in the 'Build Positive Change' Project or parts thereof (the “Recordings”). 

I agree that the project may be edited and otherwise altered at the sole discretion of the Producer and used in whole or in part for any and all broadcasting, non-broadcasting, audio/visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world. 

Producer may use and authorise others to use all or parts of the Recordings. Producer Belfast Bohemian Productions, its successors and assigns shall own all right, title and interest, including copyright, in and to the Program, including the Recordings, to be used and disposed of without limitation as Producer shall in its sole discretion determine.
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Contributor's Name *
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I hereby confirm my age. *
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