(Short Release Form)

Participant (Full Name) Mr/Ms/Mrs:
The Programme Title / Working Title / Production Ident:
Production (Interview) Date/s:
Location:

I authorise Producer/Production Company to record and edit into the programme described above, my name, likeness, image, voice, interview, and performance. Producer/Production Company shall own all rights, title, and interest in and to the programme, including the recordings. The Producer/Production Company shall in its sole discretion, without limitation, determine how the programme and media is used and disposed of.

Participant’s Signature:

Date:

Full Address:

Contact Number / Email:

ADDITION FOR MINORS

I represent that I am the parent and/or legal guardian of the minor who has signed above or is the participant in the programme. I agree that we both shall be bound by this agreement.

Parent’s / Guardian’s Signature:

Age of Minor:

Date: