CONSENTANDRELEASEFORM

ProductionCompany:____________________________________________________
PictureTitle:____________________________________
Location:_______________________________________
Ihaveparticipatedasindicatedontheabovemotionpicture(the"Picture").Inconsiderationof
myappearanceinthePicture,andwithoutanyfurtherconsiderationfromyou,Iherebygrant
permissiontoyoutoutilizemyappearanceinconnectionwiththePictureinanyandallmanner
andmediaandallrightsofeverykindandcharacterwhatsoeverinperpetuityinandtomy
performance,appearance,nameand/orvoiceandtheresultsandproceedsthereof(the
"Performance")inconnectionwiththePicture,andIherebyauthorizeProductionCompanyto
photographandrecord(onfilm,digital,video,tape,orotherwise),thePerformancetoeditsame
atitsdiscretionandtoincludeitwiththeperformanceofothersandwithsoundeffects,special
effectsandmusictoincorporatesameintothePictureorotherprogramornottouseandto
licenseotherstousesuchrecordingsandphotographsinanymannerormediawhatsoever,
includingwithoutlimitationunrestricteduseforpurposesofpublicity,advertisingandsales
promotionandtousemyname,likeness,voice,biographicorotherinformationconcerningme
inconnectionwiththePicture,commercialtieups,merchandising,andforanyotherpurpose.I
furtheracknowledgethatProductionCompanyownsallrightstotheresultsandproceedsofmy
servicesrenderedinconnectionherewith.
IagreethatmyparticipationinthePicturemaybeeditedinyoursolediscretion.Iconsenttouse
ofmyname,likeness,voiceandbiographicalmaterialaboutmeinconnectionwithPicture
publicityandrelatedinstitutionalpromotionalpurposes.Iexpresslyreleaseyou,youragents,
employees,licenseesandassignsfromandagainstanyandallclaimswhichIhaveormay
haveforinvasionofprivacy,defamationoranyothercauseofactionarisingoutofproduction,
distribution,broadcastorexhibitionofthePicture.
PerformerParticipantsSignature:________________________________________________
PrintName:__________________________________________________________________
ContactInfo:_________________________________________________________________
Date:______________________________________
IrepresentthatIamaparent(guardian)oftheminorwhohassignedtheabovereleaseandI
herebyagreethatweshallbothbeboundthereby.
Signature:_____________________________________Date:__________________________
Name:________________________________________