Sample Actor Release Form

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Sample Actor
Release Form
I, _________________________________________________________, hereby authorize
______________________________ to use my photograph, performances, plays, actions
and appearances in connection with the video production titled: ___________________
_________________________________________________________________________
I grant the right to use all the recordings you make of me and my voice and the right to
use my name in connection with this video production. I release the producer from any
lawsuits, actions or demands whatsoever in connection with using my likeness and voice
in this production.
I certify that I am 18 years of age or older* and fully understand the meaning and intent
of this contract.
Name: ________________________________________________________________
Address: ______________________________________________________________
City: _________________________________________________________________
Province: ______________________________________ Postal Code: _____________
Phone: _______________________________________________________________
Signature: _____________________________________________________________
Date: ________________________________________________________________
Witness:_______________________________________________________________
*If under the age of 18, this form needs to be completed by parent or legal guardian.

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