PHOTOGRAPH/VIDEO/AUDIO-CONSENT AND WAIVER
I hereby grant full permission to the Film LLC to prepare, use, reproduce, publish, distribute and exhibit my name, picture, portrait, likeness, or voice, or any or all of them in or in connection with the production of a motion picture film, television videotape or live program, video recording, sound track recording, or still photography in any manner including website postings for educational, treatment, scientific, marketing, publication, informational and any other professional purpose deemed necessary. I hereby waive all rights of privacy or compensation which I may have in connection with the use of my name, picture, portrait, likeness or voice, or any or all of them, in or in connection with said motion picture film, television videotape or live program, video recording, sound track recording, or still photography and any use to which the same or any material therein may be put, applied or adapted by the Film LLC, and any of its agencies. Consent given below is valid until the deems it otherwise, or until consent is revoked by he/she signed below.
grant permission for the use of my information as stated above by the Film LLC.
Phone phone number
Parent or Legal Guardian (if participant is a minor or unable to sign)