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Whereas, __________________________________________ (the “Producer”) 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 appearing in this production, 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 t 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. This Release shall be governed by Massachusetts law.
I hereby certify that I have read, understood, and agreed to the foregoing.
General ReleaseForm for a Minor
to Appear in a Video or Television Production
SCA102Rev01 - 12/2011
Parent/Guardian NameParent/Guardian SignatureDate Signed
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