read the consent form carefully and click "I accept" or "I do not accept" at the end of it.
your contact information will be kept confidential.

CONSENT FORM

PRODUCTION
Blakout.ca, Voices Silenced By Fear

You are being asked to participate in a research documentary work. Your voluntary participation includes such activities as submitting a written account of your story through this website, uploading any photos, images or other data, being filmed on camera, having your voice or your image recorded, and so on. Your participation is completely voluntary. This means you may choose not to participate at any time. Before you give your consent to be a volunteer, it is important that you read the following information and ask as many questions as necessary to be sure you understand what you will be asked to do. If you have any questions, you may contact the director by email at director@blakout.ca. For more contact options, please visit the contact page of this website.

DIRECTOR/RESEARCHER:
Esther Buckareff, BA, MFA Candidate
Documentary Media, Ryerson University

THESIS SUPERVISOR
Lila Pine, PhD
lpine@ryerson.ca

PURPOSE OF THE RESEARCH: The purpose of this documentary work is to facilitate a voice for individuals who have been bullied, silenced and/or unfairly treated by representatives of democratic institutions. Democratic institutions include organizations such as ministries, government agencies, schools, hospitals, and so on, which are government-funded through taxpayer's money. Your participation enables you to describe a situation where you feel you were intimidated or treated in a way that was unfair to you by government workers, bureaucrats, elected politicians or other authority figures that are connected to or employed by a democratic institution.

The goal of this project is to create a simulated democratic model. (A democracy is defined as a society that governs its own destiny by voting for its leaders through a free electoral system. Canada is a democracy.) The research investigates how an oppressed public can affect the workings of a democracy if voices that were silenced are facilitated and heard. For purposes of this work, a person is oppressed when a social justice crime is committed against them, which involves the violation of their human rights according to the Canadian Charter of Rights and Freedoms and the Canadian Human Rights Act. This project endeavours to give oppressed individuals the voice that they are entitled to exercise in a democracy.

PROCEDURES OR METHODS TO BE USED: This form is designed to collect data regarding your story. Your story may be edited and/or summarized before it is published to the Internet. This is a directed documentary, which means that it is at the Director's discretion whether or not to publish your story to the website, or to create a short film out of your story. The average film length is 5-10 minutes. If a film is created from your story, it may or may not be published to the website or be made available for public viewing. Some films may be shown in public spaces such as a cinema or TV, and/or published online.

The editing process is at the discretion of the director and may exclude you. However, you may be contacted for clarification of facts or events pertaining to your story. If you feel the edited film or written summary does not fairly represent you, you may request the director to remove any content related to your story from public viewing. There is no cash remuneration for your participation. This website and any films on the website are available for free to the public.

At the end of this form, there is a check box that allows you to choose to be notified when your story is published. To be notified, you must provide a valid email address. For your story to be included in this documentary project, you are required to provide a means to be contacted. Please make sure the phone number and/or email address that you provide is correct. Unless you specify otherwise, your contact information will be kept confidential.

You may also choose not to be visually or audibly identified. You may also choose not to be identified through the written submission. During on-camera or audio only activities, you may choose to have the pitch of your voice altered, or you may choose to have a third party "stand-in" represent you visually and/or through audio. If you are filmed, there are many creative ways to disguise your appearance. You can discuss these options with the director. If concealing your identity is an important issue, you can request to view the final written, audio or filmic piece before it is made public, or during the editing process.

Some stories may be dramatized by incorporating re-enactment. This means that someone else may be filmed to "represent" your story. You may or may not be asked to participate in the re-enactment. If you are asked, your participation is voluntary. You may be contacted to provide clarification for your story and/or for an on-camera or audio-only interview. You may be asked specific questions about yourself and your situation, and/or you may be asked to tell your story.

The documentary work will be available on the Internet indefinitely pending the availability of funding to enable its existence.

WHAT IS EXPERIMENTAL IN THIS WORK: This research project is an interactive documentary. An interactive documentary is a documentary format that allows the viewer/user to interact with the project (your written submission is a form of interaction), to click on web links, access and view other people's stories, provide comments and questions, and use the mouse to interact with the films. For example, a user may jump from film to film by clicking their mouse.

RISKS OR DISCOMFORTS ANTICIPATED: What you write will likely be published on the Internet. If there is information in your story that you wish to be kept confidential, you must specify this through the online form.

DISCLAIMER AND ASSUMED RISK: You assume any legal risks that may or may not be involved if you choose to identify any public or private individuals by name. A legal risk may involve you being sued for libel or defamation if the opposing party claims that you unfairly tarnished their reputation or that your account of the situation is untrue.

"Matters of public interest":
In December 2009, the Supreme Court expanded protection for what the court refers to as "communications on matters of public interest", based on the case Grant vs. Torstar. The following is a summary of requirements when naming a public or private individual (as summarized by copyright lawyer Michael Geist):

  • The publication is on a matter of public interest
  • The publisher was diligent in trying to verify the allegation, having regard to
    (a) the seriousness of the allegation;
    (b) the public importance of the matter;
    (c) the urgency of the matter;
    (d) the status and reliability of the source;
    (e) whether the plaintiff's side of the story was sought and accurately reported;
    (f) whether the inclusion of the defamatory statement was justifiable;
    (g) whether the defamatory statement's public interest lay in the fact that it was made rather than its truth ("reportage"); and
    (h) any other relevant circumstances.

To conform to these guidelines and protect you from liability, if you choose to name individuals, you should provide contact information for each person named to enable this research work to invite their side of the story. To protect you from liability, if you do not provide contact information for the named individual(s), your story submission may or may not be published.

Please take a moment to reflect on the possible risks to your status and reputation.

BENEFITS ANTICIPATED: You will have the opportunity to include your voice in a project that we hope will allow Canadians to better understand how the inability to speak out adversely affects a democracy, and subsequently adults, children and families.

EXTENT OF CONFIDENTIALITY: Full confidentiality will be maintained in accordance to the requirements of your disclosure. For participants who agree to "on camera" or just audio participation, confidentiality will be maintained to the extent described under "Procedures and Methods." The Director will have access to the data. The data is secured on a server encrypted with SSL technology. If you provide your email and/or phone information, you will be notified of any footage that includes your story prior to publication.

TERMS OF PARTICIPATION: I understand that my participation is completely voluntary. Your choice of whether or not to participate will not influence your future relations with Ryerson University. I also understand that if I decide to participate in this study, I may withdraw my consent and stop participating at any time without explanation and without penalty. I consent to the reproduction of my data, by means of digital audio/video recording or photography. I understand that my story may be used in the production of a documentary, which will likely be accessible on the Internet and possibly through other media channels as well.

If you have questions regarding your rights as a human subject and participant in this study, you may contact the Ryerson University Research Ethics Board for information.

Research Ethics Board
c/o Office of the Vice President, Research and Innovation
Ryerson University
350 Victoria Street
Toronto, ON M5B 2K3
416-979-5042

By clicking "I AGREE", you indicate that you have read the information in this agreement and have had a chance to ask any questions you have about this work. You can change your mind and withdraw your consent to participate at any time. You may print a copy of this agreement and/or have it emailed to you.

By agreeing to this consent, you are not giving up any of your legal rights.

Please complete the required information

Please enter a valid email address.

Yes, please send a copy of this consent form to my email.

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