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====Talent Release Form Sample====

<WRAP centeralign><fs xx-large>True Images Productions</fs>\\ <fs x-large>Standard Media/Talent Release</fs></WRAP>
<wrap right>Date: <nowiki>____________________</nowiki></wrap>\\ 

I, <nowiki>________________________________________________</nowiki> //(printed name of person appearing in the video)// hereby grant to Steve Isenberg and Evie
Tse, d/b/a True Images Productions, independent producers, the right and permission to use my image as part of a video program to be broadcast on community cable stations including LexMedia, the cable access provider for Lexington Massachusetts, posting on YouTube, and for other uses by the producers. This use includes my video, still images, and voice. I hereby release and discharge the producers from any and all claims and demands arising out of or in connection with the use of the images and my name, likeness, and identity, including without limitation any and all claims for libel, privacy, or publicity.

I have read the foregoing and fully understand and agree to the contents thereof.
\\ \\ 

Signature: <nowiki>_________________________________________________</nowiki> Date:  <nowiki>_____________________</nowiki>\\ 
//Signature of person appearing in video//

Address: <nowiki>______________________________________________________________________________</nowiki>


Phone:<nowiki>__________________________</nowiki> eMail:<nowiki>________________________________________________</nowiki>

<WRAP box>
//If the above person is a minor, then a parent or legal guardian must complete this section.//

I am the parent or legal guardian of the above named person who is a minor and I am permitting use of his/her video, still image, and voice to the producers. I hereby consent to and join in the foregoing grant, release, and consent on behalf of said minor.


Print parent’s or guardian’s name: <nowiki>______________________________________________</nowiki>


Signature: <nowiki>_________________________________________________</nowiki>


Birth Date of Minor: <nowiki>__________________________________________</nowiki>
</WRAP>
<WRAP box>
How should you (or your child) be identified or credited on the video?  Please specify below if you would prefer to be identified using something other than just the name specified above.  (e.g., “John Smith, PhD, DDS” or "Julie" and thus not using her last name)
\\ \\ \\ \\ \\ \\ \\ </WRAP>
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