Photographers Release Form

DATE:_____________________

Print Name: _______________________________________________________________

Address: __________________________________________________________________        

Town/City: ______________________________________ST:__________Zip:___________

If minor, Parent Name:________________________________________________________



I, the undersigned, give___________________________________ (production company or photographer) permission to photograph or videotape me. I hereby confirm this individual or company owns all rights in and to all results and proceeds of all services heretofore rendered by me including all acts, poses, plays, appearances, photographs, and recordings of me, and including the right to reproduce, use and perform the same perpetually in any manner whatsoever, by any present or future means and as well as the perpetual use to use my name, photographs (still or moving) and recordings for commercial and advertising purposes, and to "dub" my voice and sound or sound effects produced by me. I hereby confirm that I have accepted this agreement on these terms and conditions set forth herein.

Signature: ____________________________________________           

Telephone: ____________________________________________           

Email Address: ________________________________________

Photographer or Producter Name:__________________________________________

Company:_____________________________________________________________

Address:_______________________________________________________________

Tel:_________________________________Cel:_______________________________