Census Digital Function Testing

STATEMENT OF RELEASE

Thank you for agreeing to participate in this study. Your privacy and the privacy of your answers will be respected and maintained. Your personal information will not be disclosed and your individual answers will only be presented at an aggregate level. You will not be sold anything, or asked for money, under the guise of research. Your decision to participate in a study, answer specific questions, or discontinue your participation will be respected without a question. Each interview will be recorded and may be observed.

You acknowledge and agree that you have read this Statement of Release and fully understand its contents. You release and hold harmless Market Analytics and the US Census and its employee(s), officers, owners and directors from any and all injury and damages, which may arise directly or indirectly, from your participation in this study.

Name of Participant: _________________________________ Age: ______

Signature of Participant: ______________________________

Date: _______________

Address: _____________________________

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