Film Production:
Personal Release

I, _________________________, have agreed to be photographed and/or recorded by Film Production Company (the “Production Company”) and that they and their successors shall own all rights of every kind in said photography and/or recording. I am granting a release to allow employees, agents and guests of the Production Company (the “Production Persons”) to record, film, photograph, or videotape material and/or segments of a program featuring my voice, image, and property (the “Material”).

I hereby grant Production Persons, their successors, licensees and assign the nonexclusive right, but not the obligation, to use the Material in connection with and as part of the Film Production Title and for advertising, promotional and publicity purposes.

I hereby grant Production Persons, their successors, licensees and assigns from and against any and all claims, causes of action, suits, cost liabilities and damages whatsoever that I now or hereafter may have against them in connection with preparation, production and use of the Material.

I warrant that I am fully authorized to grant the rights described in the letter.

(PLEASE PRINT CLEARLY)

Signature: ___________________________ Date: __________

Print Name: _________________________________________

Parents’ signature (if minor): ___________________________

Address: ____________________________________________

City/State/Zip: ________________________________________

Phone: ____________________Mobile:___________________

Email: ______________________________________________
By:
Production:
Scene:
Date:
Note: