Media Consent Release Form

Media Consent Release Form

Parties and Contact Information

Recitals

WHEREAS, Releasor desires to participate in the production, creation and recording of certain media materials related to the project entitled "";

WHEREAS, Releasee intends to photograph, record, reproduce, edit and otherwise use such photographs, audiotapes, videotapes and related media (collectively, "Media") for the purposes described in this agreement;

WHEREAS, the parties wish to set forth the terms under which the Media may be used and the rights granted by Releasor to Releasee.

Scope of Work

Rights Granted

Releasor hereby grants to Releasee a perpetual, irrevocable, worldwide, royalty-free license to use, reproduce, publish, distribute, display, perform, create derivative works of and otherwise exploit the Media in any medium now known or hereafter developed for the following purposes:

Territory:    |    Exclusivity:

Payment Terms

Consideration: In exchange for the rights granted herein, Releasee will pay Releasor the amount of USD.

Late payment shall accrue interest at the rate of on any past-due amount.

Term and Termination

Term Commencement Date:    Term End Date:

Either party may terminate this Agreement for material breach by providing written notice and an opportunity to cure as set forth below. Notice period: days.

Termination shall not affect Releasee's right to use Media acquired and distributed prior to termination in accordance with the rights granted and consideration paid.

Confidentiality

The parties acknowledge that certain information exchanged in connection with the Media and the Scope of Work may be Confidential. Each party shall hold Confidential Information in confidence and shall not disclose it to third parties except as required by law or as necessary to exercise rights under this Agreement.

Release, Warranties and Indemnity

Releasor represents and warrants that Releasor is the person identified above and has full authority to grant the rights set forth herein. Releasor hereby releases, waives, discharges and covenants not to sue Releasee for any claims, demands, or causes of action related to the use of the Media, including but not limited to claims for invasion of privacy, libel, defamation or infringement of moral rights. Releasor agrees to indemnify and hold Releasee harmless from any third-party claims arising out of Releasor's breach of this Agreement or misrepresentations of authority.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state of , without regard to its conflict of laws principles.

Entire Agreement

This Agreement, including any schedules and attachments, constitutes the entire understanding between the parties with respect to the subject matter hereof and supersedes all prior negotiations, understandings and agreements. Any modification of this Agreement must be in writing and signed by both parties.

Minor Consent (If Applicable)

Is the Releasor under the age of 18?

If the Releasor is a minor, the undersigned parent or legal guardian hereby consents to the foregoing on behalf of the minor and warrants authority to do so.

Acknowledgement and Certification

By signing below, Releasor certifies that Releasor has read this Media Consent Release Form in its entirety, understands its terms, and consents to the use of the Media as set forth above. Releasor acknowledges that no additional compensation will be due beyond the Consideration specified herein, unless otherwise agreed in writing.

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