Release Form

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Talent Agreement and Release

For the valuable consideration which is hereby acknowledged, I hereby grant the following rights from my or my minor child’s participation in said student motion picture entitled

at California State University, Northridge. This motion picture is for academic purposes in the Department of Cinema and Television Arts. 1. The right to use my name, photograph, likeness, acts, poses, and appearance made in any manner. To record, reproduce, amplify, and simulate my voice and to reproduce, distribute, publish, exhibit, and/or transmit the same by any mechanical or electrical means for any purposes whatsoever in perpetuity. 2. The right to double or “dub” my voice, acts, poses, and appearances to such extent as may be desired.

Name (print): Address: Signed: Date: Witness:

S.S.#: