Consent for Video/Audio Recordings & Photographs for Students

Consent for Video/Audio Recordings & Photographs
Elon University Department of Physical Therapy Education
Student Form

There are instances in Physical Therapy Education in which audiovisual (AV) materials and interviews are used to enhance the learning experience. AV materials provide a good method of feedback, examination and re-examination of techniques, and record keeping. For several classes, you may be asked to videotape, photograph, or record yourself or one of your classmates. The tapes will be kept as long as they can be used for pertinent educational use. There will be no pre-imposed time limit.

The Department of Physical Therapy Education (DPTE) at Elon University is committed to the highest standards in teaching and research. Knowledge and understanding in Physical Therapy are often greatly enhanced when the possibly abstract course instructions are supplemented with real and recorded examples of human movements and behavior. Audiovisual materials such as videotaped sessions and photographs provide an invaluable resource of feedback for participants and a powerful learning opportunity for an examination of physical therapy techniques.

The Elon University Department of Physical Therapy Education uses such recorded material strictly for educational purposes and seeks always to avoid embarrassment for participants and disclosure of personal information. Our mission is for use of recorded materials in an ethical and responsible manner that does not violate the trust between client/volunteer and practitioner.

While DPTE will work diligently to protect participant identities, in some cases it is not possible to maintain complete anonymity. For that reason, and to clearly record your wishes with respect to the use of your visual image, we ask that you complete the attached consent form. While we would, of course, welcome your willingness for DPTE to use the tapes/photographs in all settings listed, we have listed settings separately to ensure that we understand your preferences clearly.

Again, the purpose of this informed consent form.is to provide the student an opportunity to assist the faculty with to what extent the interview(s) or AV material may be used. If you have any questions regarding this form or its intended use, please ask the appropriate faculty member or DPTE representative.

It is the student's responsibility to inform each faculty member requesting AV use of the extent to which the material may be used.

Thank you for your support of our educational mission.

Department of Physical Therapy Education

Signature: ____________________________

Print Name: __________________________

Date: _______________________________