Sample Talent Release Form

Every person recorded should fill out this form including production crew.  Please submit a copy to LCA and keep a copy for your records

Talent Name: ______________________________________ __________________

Production Title:_____________________________ ___________________________

I hereby consent for (Name of your production group goes here) to use, reproduce, exhibit or distribute (in full or in part) any photographic, video, film, and/or audio recordings made of me or my likeness; and/or any written extract of such recordings in which I may be included, for any purpose whatsoever, in any medium now known or in the future invented.

I hereby release, discharge, and agree to hold harmless (name of your production group goes here) and all persons acting under its permission or authority from any liability or injury that may occur while performing or appearing in the said video, audio, or photographic production.

Talent Signature: ____________________________________________

Talent Print Name: ___________________________________________

Date: _________________________

Address: ___________________________________________________

State: __________________ Zip:___________

If Talent is a Minor under the laws of the state where acting or performing is done:

Legal Guardian: ______________________________________________________

(Print name)

Signature: ____________________________________________________ ____

Date: ________________________________

Address: ___________________________________________________ _____

State: ________________ Zip: ___________