GENERAL RELEASE WHERE TALENT FEE OR OTHER REMUNERATION
OR RECOMPENSE ACCRUES TO THE PARTICIPANT
The United States Government has requested that I grant, release, and discharge certain rights arising from
my participation, or the participation of an infant or minor child for whom I exercise custody, in a video or
audio recording or presentation entitled:
"
";
PIN
or PAN
which is being made by or produced
for the United States Government.
This grant, release, and discharge of said rights to the United States Government is made in full
cognizance of the risks inherent in the operational techniques employed in the production, including, but not
limited to, the focusing of lights upon me or the infant or minor child; and in contemplation of the reliance of
the United States Government upon the rights herein granted and released.
In consideration of the talent fee or other remuneration or recompense and without expectation of any
further compensation of any kind, I hereby grant and release to the United States Government the following
rights:
a. To use my name, or that of said infant or minor child, in any manner; photographs, likenesses, acts,
poses, plays, and appearances made in connection with the said production, to record, reproduce, amplify,
simulate, filter or otherwise distort my voice or the child's voice, and all instrumental, musical, and other
sound effects produced by me or by the child; and to reproduce, duplicate, publish, exhibit, use or transmit
the same or any parts thereof, by any means, in any manner and for any purpose whatsoever; and to do the
same perpetually.
b. To "double" or "dub" my voice, acts, poses, plays, and appearances, or those of the infant or minor
child, and all instrumental, musical and/or other sound effects produced by me or the said infant or minor child
to such extent as may be desired by the United States Government.
I release and discharge the United States Government from any cause of action arising from my
participation or the participation of the infant or minor child in the production.
This grant, release, and discharge shall inure to the benefit of the United States Government, and its
officers, agents, servants, and employees when acting in their official capacities; and to persons, firms or
corporations contracting with the United States Government, and their heirs, executors, administrators,
successors, or assigns; and to any other persons lawfully reproducing, distributing, exhibiting, or otherwise
using the said production or any portion thereof.
The person or persons granting and releasing the rights set forth above are as follows:
1. TALENT
a. TYPED OR PRINTED NAME
b. SIGNATURE
c. DATE
(Last, First, Middle Initial)
(If under 18 years of age, parent or guardian
(YYYYMMDD)
must sign below.)
2. PARENT OR LEGAL GUARDIAN (Complete if talent is under 18 years of age.)
a. TYPED OR PRINTED NAME
b. SIGNATURE
c. DATE
(Last, First, Middle Initial)
(YYYYMMDD)
3. WITNESS
a. TYPED OR PRINTED NAME
b. SIGNATURE
c. DATE
(Last, First, Middle Initial)
(YYYYMMDD)
DD FORM 2831, OCT 2000
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