CONSENT AND RELEASE
By signing this form, I give my consent to Clearwater Filmworks to use and Reproduce my name, voice and picture in a program to be aired by on a not for profit cable television station. I also agree to the use of my name, voice and picture in program publicity materials, for non-broadcast showings to private groups and for educational television production.
By signing this form, I also release Clearwater Filmworks from any claim I might have against it because of the use of my name, voice and picture including for example, any claim based on defamation, slander, libel or invasion of privacy, I also release the rights to air or cablecast on any media. (Cable systems, Broadcast and or Web).
I also release Clearwater Filmworks’s affiliations and any stations or networks making use of my name, voice and picture as well as the director, officers, employees or agents of any of the above organizations.
I acknowledge that I will receive no money from Clearwater Filmworks for giving this consent and release. I am an adult (18 years of age or older). I have read and understand this form
DATE: ________/_______/_______
PRINT NAME of TALENT or CHILD: _______________________________________________________________________
PRINT NAME OF TALENT/PARENT OR GUARDIAN: _______________________
SIGNATURE of Parent or Guardian or Talent: _________________________________
STREET ADDRESS:_____________________________________________________
CITY_________________________________STATE___________ZIP_____________
SIGNATURE of WITNESS:__________________________________________
OFFICE USE ONLY
TITLE OF SHOW:
SHOW PRODUCER:
DATE SHOW WILL AIR: ____________/_____________/_____________