Seniorocity-VR Pilot Community Consent

WELCOME TO SENIOROCITY VR™
Let’s Get Started!

Please review the information below before participating.

unchecked Participation is voluntary.

unchecked I may stop at any time.

unchecked I understand that VR experiences are generally conducted while seated and may cause dizziness, motion discomfort, eye strain, balance disturbances, or emotional reactions for some participants. I will notify staff if I experience discomfort or wish to stop.

Participant Acknowledgment

Questions? Please ask a facilitator before participating.

I have reviewed the information above and voluntarily choose to participate in Seniorocity VR™ activities.

Participant Name:

_____________________________

Signature:

_____________________________

Date:

__________________________________

OPTIONAL MEDIA & TESTIMONIAL PERMISSION

unchecked YES, I grant permission for photographs, video, audio recordings, comments, testimonials, and related materials from my participation to be used by Seniorocity VR™ and the American Family Center for educational, promotional, fundraising, and program-related purposes.

unchecked NO, I do not grant permission.