Talent Release Form - Hawaii Pacific University


HPU STUDENT PROJECT NAME: ___________________________________________________
HPU Course Alpha Numeric and Title: _________________________________________________
Fall / Spring / Summer semester 20___
INSTRUCTOR'S NAME: ___________________________________________________________________
I hereby consent to the use of all images (in any format including but not limited to photographs,
videotapes, or film) taken and or/or recordings made of my voice and/or likeness made at
(RECORDING LOCATION) _________________________________________________________
on (DATE(s)) ____________________________________________________________________
by (PRODUCER(s)) _______________________________________________________________
for Hawai'i Pacific University and the HPU Student Project identified above. This HPU Student Project
is intended as an academic work and is not intended for commercial distribution or sale. Hawai'i
Pacific University may use, edit and reuse my images, voice and likeness for non-commercial
educational purposes, promotional or advertisement reasons in any and all media, now known or later
I understand that there will be no financial or other remuneration for use of my image, voice or
likeness. I waive any right I may have to inspect or approve any use of my image, voice or likeness
and hereby release the HPU Student Project and its producers and the University and its agents,
employees, successors and assigns from any liability resulting from or connected with such use.
TALENT NAME (PRINTED); ________________________________________________________
TALENT EMAIL-PHONE: ___________________________________________________________
STREET ADDRESS: ______________________________________________________________
CITY: ________________________
STATE: ________________
ZIP CODE: ____________
TALENT NAME (SIGNATURE); ______________________________
DATE: ________________
If the subject is a minor under the laws of the state where modeling, acting or performing is done,
complete the following:
GUARDIAN NAME (PRINTED): ______________________________________________________
GUARDIAN EMAIL-PHONE: _________________________________________________________
STREET ADDRESS: _______________________________________________________________
CITY: ________________________
STATE: ______________
ZIP CODE: _____________
GUARDIAN NAME (SIGNATURE):_______________________
DATE: _________________


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