Codsall Community High School

Elliotts Lane

Codsall

Wolverhampton

WV8 1PQ

Monday 13th July 2015

As you are already a wear, in September 2015 recording will begin for our A2 Media Coursework. We will be creating a music video for the song ‘Taylor Swift ‘Out of the Woods’. You have been asked to take part in the filming of this video as an actress, actor or dancer. By signing below you agree in taking part within the music video and are understand that it will be used online within our coursework, put online for the public to see and on other distribution platforms.

Thank you in advanced for your cooperation.

Charlotte Bell, Kate Harrold, Samantha Leason and Sophie Ordidge.

Role within music video

Name of Participant

Signature of Participant

Date Signed

Actress/Singer Kate Harrold K.Harrold 15.7.15

Dancer Samantha Leason Samantha.L

15.7.15

Actor James Ellis James.O.Ellis 15.7.15