PROD:
PRODUCTION TITLE:
PRODUCER:
DIRECTOR:

ACTOR RELEASE FORM

To Whom It May Concern:

I (the undersigned) hereby grant to _____________________________ the right to photograph me and to
record my voice, performances, poses, actions, plays and appearances, and use my picture, photograph,
silhouette and other reproductions of my physical likeness in connection with the motion picture
tentatively entitled (the “Picture”).

I hereby grant to _____________________________, its successors, assigns and licensees the perpetual
right to use, as you may desire, all still and motion pictures and sound track recordings and records which
you may make of me or of my voice, and the right to use my name or likeness in or in connection with the
exhibition, advertising, exploiting and/or publicizing of the picture. I further grant the right to reproduce in
any manner whatsoever any recordings including all instrumental, musical, or other sound effects produced
by me, in connection with the production and/or postproduction of the Picture.

I agree that I will not assert or maintain against _____________________________, your successors,
assigns and licensees, any claim, action, suit or demand of any kind or nature whatsoever, including but not
limited to those grounded upon invasion of privacy, rights of publicity or other civil rights, or for any reason
in connection with your authorized use of my physical likeness and sound in the Picture as herein provided.

By my signature here I understand that I will, to the best of my ability, adhere to the schedule agreed to prior
to the beginning of my engagement. Additionally, I agree, to the best of my ability, to make myself available
should it be necessary, to rerecord my voice and/or record voice-overs and otherwise perform any necessary
sound work required after the end of filming. Should I not be able to perform such sound work, I understand
that _____________________________ may enter into agreement with another person to rerecord my
dialogue and/or record voice-overs and use this sound work over my picture or however they deem
appropriate.

I hereby certify and represent that I am over 18 years of age and have read the foregoing and fully
understand the meaning and effect thereof.

Name:

Address:

Telephone:

Signature:

Date:

Character Name:

Producer Signature:

Producer Telephone: