Video Release Form printable pdf download

Video Release Form

I hereby grant permission to the rights of my image, likeness and sound of my voice as submitted on video

tape without payment or any other consideration. I understand that my image may be edited, copied,

exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my

likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the

use of my image or recording.

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

electronically displayed via the Internet and television broadcast.

There is no time limit on the validity of this release nor is there any geographic limitation on where these

materials may be distributed.

By signing this form I acknowledge that I have completely read and fully understand the above release and

agree to be bound thereby.

Home Video File Name____________________________________________________________

Full Name_____________________________________________________

Street Address/P.O. Box________________________________________________________________

City _____________________________________________________

Prov/State_________________________________________________

Postal Code/Zip Code________________________________________

Phone ____________________________________________________

Email Address_________________________________________________________________________

Signature_____________________________________________ Date___________________________

If this release is submitted on behalf of someone under the age of 19, then the signature of that presenter’s

parent or legal guardian is also required.

Parent/Guardian Name____________________________________________________________

Signature______________________________________ Date____________________________

Video Release Form