# Informed Consent Form for Audiovisual Data Collection and De-identification

**SYNAPSIS Project Template - English Version**

---

## Study Information

| Field | Details |
|-------|---------|
| **Study Title** | [Insert study title] |
| **Principal Investigator** | [Name, Institution] |
| **Contact Email** | [Email address] |
| **Ethics Approval Number** | [IRB/Ethics committee reference] |
| **Date** | [DD/MM/YYYY] |

---

## Purpose of the Study

[Briefly describe the research objectives and why audiovisual data is being collected]

---

## What Participation Involves

You are being asked to participate in a research study that involves:

- [ ] Video recording of [describe context: interview, classroom, experiment, etc.]
- [ ] Audio recording of [describe context]
- [ ] Duration: approximately [X] minutes/hours
- [ ] Location: [specify location]

---

## Data Processing and De-identification

Your audiovisual data will be processed using the SYNAPSIS platform (https://synapsis.nl), which applies privacy-preserving techniques:

### Face De-identification
- [ ] **Face blurring**: Faces will be blurred to prevent identification
- [ ] **Face masking**: Faces will be replaced with synthetic faces while preserving expressions
- [ ] **Pixelation**: Facial regions will be pixelated
- [ ] **Other**: [specify method]

### Voice Anonymization
- [ ] **Pitch shifting**: Voice pitch will be modified
- [ ] **Formant modification**: Voice characteristics will be altered
- [ ] **No voice modification**: Audio will remain unaltered
- [ ] **Audio removal**: Audio track will be removed entirely

### Body Data Extraction
- [ ] **Pose extraction**: Body movement data (skeleton points) may be extracted
- [ ] **Gesture analysis**: Hand and body gestures may be analyzed
- [ ] **No body data extraction**

---

## Data Storage and Security

- **Processing Location**: Data will be processed on SURF infrastructure within the Netherlands
- **Encryption**: All data is encrypted during transfer and storage
- **Retention Period**:
  - Original (unmasked) data: Deleted after [X days/months] or upon your request
  - De-identified data: Retained for [X years] for research purposes
- **Access Control**: Only authorized researchers will have access to the data

---

## Data Sharing and Archiving

De-identified data may be:

- [ ] Archived with DANS (Data Archiving and Networked Services) for long-term preservation
- [ ] Shared with other researchers for secondary analysis
- [ ] Used in publications (in anonymized/aggregated form)
- [ ] Made available as open data under [specify license, e.g., CC-BY]

**Note**: Only de-identified data will be shared. Your identity will not be disclosed.

---

## Your Rights Under GDPR

As a participant, you have the right to:

1. **Access**: Request a copy of your personal data
2. **Rectification**: Correct inaccurate personal data
3. **Erasure**: Request deletion of your data (before de-identification is complete)
4. **Restriction**: Limit how your data is processed
5. **Portability**: Receive your data in a structured format
6. **Objection**: Object to processing of your data
7. **Withdraw consent**: Withdraw at any time without consequences

To exercise these rights, contact: [Data Protection Officer contact]

---

## Risks and Benefits

### Potential Risks
- Minimal risk of re-identification despite de-identification measures
- [Any other study-specific risks]

### Potential Benefits
- Contributing to research on [topic]
- [Any direct benefits to participant]

---

## Voluntary Participation

Your participation is entirely voluntary. You may:
- Decline to participate without any consequences
- Withdraw at any time during recording
- Request deletion of your data within [X days] of recording

---

## Consent Declaration

By signing below, I confirm that:

- [ ] I have read and understood this information sheet
- [ ] I have had the opportunity to ask questions
- [ ] I understand that my participation is voluntary
- [ ] I understand how my data will be processed and de-identified
- [ ] I understand my rights under GDPR

### Consent for Data Collection

- [ ] I consent to video recording
- [ ] I consent to audio recording
- [ ] I consent to extraction of body movement data

### Consent for Data Use

- [ ] I consent to my de-identified data being archived for future research
- [ ] I consent to my de-identified data being shared with other researchers
- [ ] I consent to use of de-identified data in publications

---

## Signatures

### Participant

| | |
|---|---|
| **Name** | _________________________________ |
| **Signature** | _________________________________ |
| **Date** | _________________________________ |

### Researcher

| | |
|---|---|
| **Name** | _________________________________ |
| **Signature** | _________________________________ |
| **Date** | _________________________________ |

---

## Contact Information

**For questions about the study:**
[Principal Investigator Name]
[Email] | [Phone]

**For questions about your rights:**
[Institution Data Protection Officer]
[Email] | [Phone]

**For questions about SYNAPSIS platform:**
SYNAPSIS Project Team
babajide.owoyele@ru.nl

---

*This template is provided by the SYNAPSIS project (NWO TDCC-SSH). Adapt as needed for your institution's requirements.*

**Version**: 1.0 | **Last Updated**: January 2026