EVER GREEN REVOLUTION — VOICES FROM THE FIELD
Consent form for recorded interview, photograph and audio
(Template — adapt as needed; keep one signed copy with the participant.)

------------------------------------------------------------
ಸಮ್ಮತಿ ಪತ್ರ / CONSENT FORM
------------------------------------------------------------

Project: Ever Green Revolution — a public, non-commercial website
documenting agriculture in Chitradurga district.
Contact: Dr. Prahlada N.B., Karnataka ENT Hospital & Research Center,
Chitradurga · prahladnb@gmail.com

Participant name: ______________________________________________
Village / taluk: _______________________________________________
Date: ____________________

WHAT I AM AGREEING TO (tick what you permit):

[ ] My words, recorded as a short audio clip (about 60–90 seconds),
    may be published on the website with an English/Kannada transcript.

[ ] My photograph (portrait) may be published on the website
    alongside my words.

[ ] My first name / full name may be shown.
    Name to display: ____________________   OR  [ ] keep me anonymous.

HOW IT WILL BE USED:
- Only for this non-commercial public-good website and its social posts.
- It will NOT be sold, licensed for advertising, or shared for any
  unrelated purpose.
- Only what I have ticked above will be used.

MY RIGHTS (Digital Personal Data Protection Act, 2023):
- This is voluntary. I can decline any question.
- I can WITHDRAW my consent at any time by contacting the number/email
  above; my photo, audio and name will then be removed from the site
  within a reasonable time.
- I can ask for a copy of my recording.

Participant signature / thumb impression: _____________________

Recorded by: ___________________________   Date: ______________

------------------------------------------------------------
ಭಾಗವಹಿಸುವವರ ಹಕ್ಕುಗಳನ್ನು ಮೌಖಿಕವಾಗಿ ಕನ್ನಡದಲ್ಲಿ ವಿವರಿಸಿ,
ನಂತರ ಸಹಿ / ಹೆಬ್ಬೆಟ್ಟಿನ ಗುರುತು ಪಡೆಯಿರಿ.
(Explain these rights aloud in Kannada before taking the signature.)
------------------------------------------------------------