Whereas, -----?----- is engaged in a project (the "Video"), and whereas, I, the undersigned, have agreed to appear in the Video, and whereas, I understand that my voice, name, and image will be recorded by various mechanical and electrical means of all descriptions (such recordings, any piece thereof, the contents therein and all reproductions thereof, along with the utilization of my name, shall be collectively referred to herein as the "Released Subject Matter"), Therefore, in exchange for $1.00, receipt of which is hereby acknowledged and whose sufficiency as consideration I affirm, I hereby freely and without restraint consent to and give unto the Producer and its agents or assigns or anyone authorized by the Producer, (collectively referred to herein as the "Releasees") the unrestrained right in perpetuity to own, utilize, or alter the Released Subject Matter, in any manner the Releasees may see fit and for any purpose whatsoever, all of the foregoing to be without limitation of any kind. Without limiting the generality of the foregoing, I hereby authorize the Releasees and grant unto them the unrestrained rights to utilize the Released Subject Matter in connection with the Video's advertising, publicity, public displays, and exhibitions. I hereby stipulate that the Released Subject Matter is the property of the Producer to do with as it will. I hereby waive to the fullest extent that I may lawfully do so, any causes of action in law or equity I may have or may hereafter acquire against the Releasees or any of them for libel, slander, invasion of privacy, copyright or trademark violation, right of publicity, or false light arising out of or in connection with the utilization by the Releasees or another of the Released Subject Matter. It is my intention that the above mentioned consideration represents the sole compensation that I am entitled to receive in connection with any and all usages of the Released Subject Matter. I expressly stipulate that the Releasees may utilize the Released Subject Matter or not as they choose in their sole discretion without affecting the validity of this Release I hereby certify that I am over the age of eighteen, and that I have read, understood, and agreed to the foregoing.

Print Name / Signature / Date / Address / Phone No




PROGRAM TITLE:                                                             DATE:

Permission is hereby granted to -----?----- to use the property located at consisting of for the purpose of photographing and recording scenes for the above program produced by -----?-----. Permission includes the right to bring personnel and equipment onto the property and to remove them after completion of the work. The permission herein granted shall include the right, but not the obligation, to photograph the actual name connected with the premises and to use such name in the program(s). The undersigned hereby gives to -----?-----, its assigns, agents, licensees, affiliates, clients, principals, and representatives the absolute right and permission to copyright, use, exhibit, display, print, reproduce, televise, broadcast and distribute, for any lawful purpose, in whole or in part, through any means without limitation, any scenes containing the above described premises, all without inspection or further consent or approval by the undersigned of the finished product or of the use to which it may be applied. -----?----- hereby agrees to hold the undersigned harmless of and free from any and all liability and loss which -----?-----, and/or its agents, may suffer for any reason, except that directly caused by the negligent acts or deliberate misconduct of the owner of the premises or its agents. The undersigned hereby warrants and represents that the undersigned has full right and authority to solely enter into this agreement concerning the above described premises, and that the undersigned hereby indemnifies and holds -----?-----, and/or its agents, harmless from and against any and all loss, liability, costs, damages or claims of any nature arising from, growing out of, or concerning the use of the above described premises except those directly caused by the negligent acts or deliberate misconduct of -----?----- , or its agents.


Signature of Authorized Property Representative





-----?----- respectfully requests permission to use __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

which will become part of the television broadcast and/or video program entitled, __________________________________________________________________________ produced by -----?-----.

This program will be recorded on video tape for later broadcast, as well as distributed on video.

Full credit would be given to ___________________________at the close of the show in which this video is used. We sincerely hope that you will grant us the permission requested, and will indicate such by signing and returning this form. Your prompt and courteous consideration of this request is very much appreciated.



Authorized By / Position / Address / Phone No




In consideration of the sum of $ ____________________and any other good and valuable considerations, receipt of which is hereby acknowledged, I, being of legal age, hereby give --- --?-----, their licensees, successors, legal representatives, and assigns the absolute and irrevocable right and permission to use my name and to use, reproduce, edit, exhibit, project, display, copyright, publish and/or resell photography images and/or moving pictures and/or videotaped images of me with or without my voice, or in which I may be included in whole or in part, photographed, taped, videotaped, and/or recorded on [date] ____________ and thereafter, and to circulate the same in all forms and media for art, advertising, trade, competition of every description and/or any other lawful purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith. I hereby waive any right that I may have to inspect and/or approve the finished product or products or the editorial, advertising, or printed copy or soundtrack that may be used in connection therewith and any right that I may have to control the use to which said product, products, copy and/or soundtrack may be applied. I hereby release, discharge and agree to save -----?-----, their licensees, successors, legal representatives and assigns from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form whether intentional or otherwise that may occur or be produced in the making, processing, duplication, projecting or displaying of said picture or images, and from liability for violation of any personal or proprietary right that I may have in conjunction with said pictures or images and with the use thereof.


Talent/Model signature with printed name below

Address / Phone no