Model release form for video producers and photographers

For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I, the undersigned, agree as follows:

1. I agree to be photographed, recorded and videotaped by ____________________ and its agents (“Company”) in connection with my participation in ___________________________ (event) on _____________________ (date).

2. I hereby irrevocably authorize Company and its affiliates to copyright, publish, reproduce, exhibit, transmit, broadcast, televise, digitize, display, otherwise use, and permit others to use, (a) my name, image, likeness, and voice, and (b) all photographs, recordings, videotapes, audiovisual materials, writings, statements, and quotations of or by myself (collectively, the “Materials”), in any manner, form, or format whatsoever now or hereinafter created, including on the Internet, and for any purpose, including, but not limited to, advertising or promotion of Company, its affiliates, or their services, without further consent from or payment to me.

3. It is understood that all of the Materials, and all films, audiotapes, videotapes, reproductions, media, plates, negatives, photocopies, and electronic and digital copies of the Materials, are the sole property of Company. I agree not to contest the rights or authority granted to Company hereunder. I hereby forever release and discharge Company, its employees, licensees, agents, successors, and assigns from any claims, actions, damages, liabilities, costs, or demands whatsoever arising by reason of defamation, invasion of privacy, right of publicity, copyright infringement, or any other personal or property rights from or related to any use of the Materials. I understand that Company is under no obligation to use the Materials.

4. This document contains the entire agreement between the Company and the undersigned concerning the subject matter hereof.

Date: ____________________________

Signature of Participant

____________________________

Name of Participant

____________________________

Signature of Producer

____________________________

Name of Producer

____________________________

(Note: If participant is a minor, please secure the name and signature of the participant’s parent or legal guardian)