Photograph &
Video Release Form
I hereby grant permission to the rights of
my image, likeness and sound of my voice as recorded on audio or video tape without
payment or any other consideration. I
understand that my image may be edited, copied, exhibited, published or
distributed and waive the right to inspect or approve the finished product
wherein my likeness appears. I also understand that this material may be
used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may
be used for the following purposes:
- educational presentations or courses
- youtube/ online educational purposes
- Movie trailer
- movie poster
- websites
By signing this release I understand this
permission signifies that photographic or video recordings of me may be
electronically displayed via the Internet or in the public educational setting.
I will be consulted about the use of the
photographs or video recording for any purpose other than those listed above.
There is no time limit on the validity of
this release nor is there any geographic limitation on where these materials
may be distributed.
This release applies to photographic, audio
or video recordings collected as part of the sessions listed on this document
only.
By signing this form I acknowledge that I
have completely read and fully understand the above release and agree to be
bound thereby. I hereby release any and all claims against any person or
organization utilizing this material for educational purposes.
Full
Name___________________________________________________
Street Address/P.O.
Box________________________________________
City ________________________________________________________
Prov/Postal Code/Zip
Code______________________________________
Phone
___________________________ Fax _______________________
Email Address________________________________________________
Signature____________________________ Date____________________________
If this release is obtained from a
presenter under the age of 18, then the signature of that presenter’s parent or
legal guardian is also required.
Parent’s Signature_____________________
Date____________________________
This form will be used to allow my actors who are under 18 to allow them to partake in my trailer and for photographs which may be edited and put online.