Actor Pay Form
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1ACTOR/EXTRA PAY FORM
SOCIAL SECURITY #
NOTES:
Last Name
First
Known As
Call Time
Date
Show
Company
Production #
In exchange for the payment detailed on this page, I grant this production and associated entities the absolute right to
use my image, likeness, and physical representation in perpetuity, be it by my name, a fictitious name, or in character. I
waive my right to inspect this representation, as well as my right to be notified of this representation. I agree that I do
not have the right to approve or inspect any finished product. I agree to hold harmless the client and any other person
using my likeness is accordance with this production. I agree that I may not hold this production liable for
misrepresenting or defaming me, and that all alterations to my image are acceptable to me.
Performer’s Signature
Performer Phone #
WORK HOURS
MEAL BREAKS
SET DISMISSAL
FROM:
FROM:
AM
AM
TO:
TO:
MEAL PENALTIES
PM
PM
AMOUNT:
*DO NOT WRITE IN THIS SECTION*
Type of Work
Hours
Rate
Total
Extras
Amount
Pay Rates
Basic:
Wardrobe
Normal
Meals
Adjusted:
Travel
1
x
Props
Overtime:
Smoke
2 x
Weather
TOTAL PAY:
Total:
Hair/Makeup
Total:
EMPLOYEE INFORMATION
SEND CHECK TO AGENT?
Employee Name
Phone Number
Agent Name
Phone Number
Street Address
Street Address
City
State
Zip
City
State
Zip
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