MODEL RELEASE FORM

The undersigned enters into this Agreement with _____________________________________________ ("Producer"). I have been informed and understand that Producer is producing a videotape program and that my name, likeness, image, voice, appearance and performance is being recorded and made a part of that production ("Product").

1. I grant Producer and its designees the right to use my name, likeness, image, voice, appearance and performance as embodied in the Product whether recorded on or transferred to videotape, film, slides, photographs, audio tapes or other media, now known or later developed. This grant includes without limitation the right to edit, mix or duplicate and to use or re-use the Product in whole or part as Producer may elect. Producer or its designee shall have complete ownership of the Product in which I appear, including copyright interests, and I acknowledge that I have no interest or ownership in the Product or its copyright.

2. I also grant Producer and its designees the right to broadcast, exhibit, market, sell and otherwise distribute the Product, either in whole or in parts, and either alone or with other products, for commercial or non-commercial television or theater, closed-circuit exhibition, home video distribution or any other purpose that Producer or its designees in their sole discretion may determine. This grant includes the right to use the Product for promoting or publicizing any of the uses.

3. I confirm that I have the right to enter into this Agreement, that I am not restricted by any commitments to third parties, and that Producer has no financial commitment or obligations to me as a result of this Agreement. I hereby give all clearances, copyright and otherwise, for the use of my name, likeness, image voice, appearance and performance embodied in the Product. I expressly release and indemnify Producer and its officers, employees, agents and designees from any and all claims known and unknown arising out of, or in any way connected with, the above granted uses and representations. The rights granted Producer herein are perpetual and worldwide.

4. In consideration of all of the above, I hereby acknowledge receipt of reasonable and fair consideration from Producer.

I have read the foregoing and understand its terms and stipulations and agree to all of them:

Model’s Name (Please Print) _____________________________________________________________

Signature ________________________________________________________ Date ________________

(If the person signing is under age 18, a parent or legal guardian must sign below.) I hereby certify that I am the parent or legal guardian of the model named above and I give my consent without reservation to the foregoing on behalf of him or her.

Signature ________________________________________________________ Date ________________

(Signature of parent or guardian)

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