I recently prepared this plain language version of Yale's video release form. Yale requires this from people being recorded as part of colloquium presentations, field methods projects, and other projects, where the videos might end up being released (e.g. published on the departmental web site, or on a project page, or used in research). It's separate from the informed consent protocol, as a student and I found recently, when we had prepared a plain language consent script, only to find that we were required to use this form with this precise wording. That precise wording, however, clearly wasn't going to be very useful to the people we were recording (most of whom don't speak much English), or to our community liaison/translator, who is excellent, but isn't trained in legal language either. There's also a fair amount of cultural information bound up in this form that might not be straightforward for someone who doesn't have a lot of experience with how things work in universities.
The solution was to prepare a parallel version of the form, with the legal wording on one side, and an explanation of what the form is, why it's needed, and what it means. I've attached it here.
You are welcome to use it as a model, or reproduce it. Note that although Yale's IRB has seen my plain language version and has approved it for this project, it's not officially endorsed. Also, I'm not a lawyer, so there may be some legal subtleties of the document that I missed. Finally, some of the plain language statements were specific to the project we were working on, and relate to a separate consent form, so they might not hold true for your project.