MODEL RELEASE FORM

Name:

Date:

Production:

University:

I hereby agree that:

1 I will take part in the production of the Production named above, and you have explained what

I need to do and what the Production is about.

2 I agree to the filming, recording and/or broadcasting of my performances (Contribution) and

agree that you can produce and exploit the Production using my Contribution (including all

versions of it). I agree that I will not withdraw my agreement to your continued use of my

Contribution (and each part of it) and use of my name, image and details about me in all

media (for example on television, in print and on the internet).

3 I agree you can use, edit, copy, adapt and translate my Contribution and the Production as

you wish. However you will not be obliged to use them.

4 I agree that I won't be entitled to any credit for my Contribution and/or the Production

(including any later versions).

5 By signing this form I transfer to you all my ownership of the copyright and other property

rights worldwide in my performances, images, and works (including all rights which exist now

and all rights which will exist in the future) relating to the Production.

6 I confirm that I am at least 18 years old.

7 I agree to keep secret and won't disclose any information which I acquire in connection with

the Production.

8 I confirm that I know of no fact or circumstance which could discredit my contribution or

damage the reputation of the Client or its services and so render the video unusable

9 This release is for the benefit of you and any person involved in the Production or use of the

Production. I agree that you can transfer to others or permit others to use the rights that I

have given you in this form.

Signed…………………………………………………………………………..... Date…………………………

Address ..................................................................................................................................................

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Tel ..........................................................................................................................................................