Media Release Form

Date *

Producer *

Name "the Person" *

Name of the person in the photograph/s and/or video/s

Address

Address of "the Person"

Mobile Number *

Best contact for "the Person" or their guardian.

Email *

Brief description of project/image

Name of Photographer

The Producer intends (but is not obliged) to produce the project. The Producer has asked you to participate in the project and you have agreed: *

1. To appear in and be interviewed, filmed and recorded for the Project and that the Producer can make recordings, films, transcripts, photographs and other records that include you, your image and voice (‘Materials’). You agree the Producer may use (and include in the Project) other content featuring or relevant to you for the purposes of the interview;
2. That the Producer will own the and Materials (including copyright on them) throughout the world in perpetuity and may distribute or use them (in whole or in part) in any and all formats and media whether now known or later devised. To avoid any doubt, if you have any rights or interest in the Project or Materials, then you hereby assign those rights and interests (including current and future copyright) to the Producer;oice
3. That the Producer may use your name, likeness, biographical material and appearance in the Project to promote the Project, the Materials and any ancillary uses;
4. That the information you provide for the Project and Materials will not be defamatory of any person or entity, breach any confidence or rights of privacy, infringe copyright or infringe any other rights of third parties or breach any laws;
5. To release the Producer from any claim by you or anyone on your behalf arising out of the Project and/or the Materials and their use and exploitation; and
6. To waive any right to seek or obtain injunctive relief to prevent or restrict the Producer’s (or the Producer’s assignees or licensees) use and exploitation of the Project and/or Materials.
7. That you are over 18 years old;
8. If this release is signed on behalf of the person appearing in the image(s), then the person’ representative warrants that it has full power and authority to bind the person and indemnifies the Producer from and against any claims arising from a break of this warranty.

Signature of Person *

Date *

Signed on Behalf of the Producer *

Date *

Media Release Form

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