Fill and Sign the Video Release Form 497331348

Release Form for Motion Picture of Video 1. I, ______________________ (full name) of ___________________________________ __________________________________________ (street address, city, state, zip code) , do hereby confirm the consent heretofore given you with respect to your photographing me in connection with your motion picture/video: _____________________ (Title) , and I hereby grant to you, your successors, assigns and licensees the perpetual right to use, in any manner or in any media currently existing or which may be developed in the future, as __________________ (Name of Releasee) may desire, all video, still and motion pictures and sound track recordings and records which you may make of me or of my voice, and the right to use my name or likeness in or in connection with the exhibition, advertising, exploitation or any other use of such motion picture or recording. 2. I understand that __________________ (Name of Releasee) will provide to me a copy of the film on DVD or other media for my personal use only. I will not sell said copy or use it for any commercial purposes such as broadcasting, streaming online or Home Video- DVD releases. I shall receive a limited license to use the copy for personal promotional purposes, which shall be limited to using a maximum of 30 seconds of the film on my personal website. I also understand that it takes a significant amount of time to complete a film. and in some cases student films are abandoned and not completed at all. If the filmmaker has promised a tape of the film, I agree to allow a reasonable amount of time to elapse after the performance for completion (i.e. six months). I agree that should the film/tape not be completed I will take no action against ____________________ (Name of Releasee) . I am over eighteen years of age. (initial here) _____ I am under eighteen years of age. (initial here) _____ _____________________________ ( P rinted name) _____________________________ (Signature) If Releasor in under the age of eighteen (18), Parents or Guardians must also sign the following Agreement. The undersigned ________________________________ (Names of Parents or Guardians) , declare that we are the Parents or Legal Guardians of the above named __________________ (Name of Child) . In such capacity as Parents or Legal Guardians, we acknowledge that we have carefully read this Release Form for Motion Picture of Video and we do hereby assume all responsibilities and obligations of ______________________ (Name of Child) a s set for therein and do specifically agree to indemnify and hold ____________________ (Name of Releasee) harmless and join in all waivers and releases of _____________________ (Name of Child) as set forth therein. WITNESS our signatures as of the ______ day of _____________, 20_____. ____________________________ _____________ Printed Name & Signature of Parent or Guardian ____________________________ _____________ Printed Name & Signature of Parent or Guardian