PROD:
PRODUCTION TITLE:
PRODUCER:
DIRECTOR:

GROUP RELEASE FORM

To Whom It May Concern:

I (the undersigned) do hereby grant to ___________________________ (hereinafter sometimes referred
to as “you”) the right to photograph me and use my picture, silhouette and other reproductions of my
physical likeness in connection with the student 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, including the right to substitute my voice for the voice of another
person or persons, 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 post production of the Picture.

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.

DATE - PRINTED NAME - SIGNATURE