Actor Release printable pdf download

Actor Release

Camille VanDevanter, DDS, MSD, PS

2011 Video Contest Release Form

ACTOR RELEASE

For good and valuable consideration, the receipt of which is hereby acknowledged,

I,____________________________________ hereby consent to the video and sound recording

of myself and the use of these recordings singularly or in conjunction with other recordings for

marketing, entertainment, and or other business purposes.

I further consent to the reproduction and/or authorization by Camille VanDevanter, D.D.S.,

M.S.D. to reproduce and use said video images and recordings of my voice, and hereby

irrevocably release Camille VanDevanter, D.D.S., M.S.D., and any of her employees from all

claims of every kind on account of such use.

By signing this release, I understand that this permission signifies that recordings of me may be

electronically displayed via the Internet or in the office of Camille VanDevanter, D.D.S., M.S.D.,

and that there is no time limit on the validity of this release.

If Model is under 18: I, ____________________, am the parent/legal guardian of the individual

named above, I have read this release and approve of its terms.

Print Name: ___________________________

Signature: ___________________________

Date: ________________________

In order for a video submission to be eligible for the 2011 Video Contest, all actors appearing in a video must

provide a signed release form. Actors under 18 years of age must obtain a release from a legal guardian

Actor Release