Talent Release Form
for LynnCAMTV
and a Producer
I hearby assign to
____________________________, the Producer of ___________________________, and
to LynnCAMTV, the right to use my likeness, voice, name and the titles of works
performed by me during my appearance on the Program ___________________, and I
here by authorize the editing, reproduction, copyright, exhibition, broadcast,
distribution and promotion of said Program by the producer and LynnCAMTV
without limitation.
I understand
that I will receive no payment for my participation in this production, and I
hereby release the above-named Producer and LynnCAMTV from any claims for
remuneration for any subsequent use of this Program.
I indemnify and
hold harmless the above-named Producer and LynnCAMTV against any and all claims
arising out of any actions or statements I make or Program material that I
provide for the videotape, including, but not limited to, any claims in the
nature of libel, slander, copyright infringement, invasion of privacy, or
publicity right, and errors of omission. I expressly release the Producer and
LynnCAMTV from any privacy, defamation, or other claims I may have arising out
of broadcast, exhibition, publication or promotion of this Program.
This Section For Adults (Please Print:)
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First Name:
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Last Name:
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Address:
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City, State, Zip:
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Phone (Day):
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Phone (Evening):
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Signature:
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Date:
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I further agree that the representations and agreements
contained in the Release are extended to my ongoing participation in this
Program.
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Signature:
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Date:
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This Section Talent (under 18 year
of age only) (Please Print:)
I warrant that I am the parent or legal guardian of the
minor described below and have the full right and authority to grant this consent
on behalf of such minor.
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Description of video, photograph, or audio recording:
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Minor's Name:
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Minor's Age
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Minor's Address:
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Minor's City, State, Zip:
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Phone (Day):
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Phone (Evening):
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Signature of parent or legal guardian:
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Printed name of parent or legal guardian:
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Address of parent or legal guardian:
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Date:
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I further agree that the representations and agreements
contained in the Release are extended to my child's ongoing participation in
this Program.
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Signature:
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Date:
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Producer name and address:
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