What is the working title of the film/video?
Who is producing the film/video? (Name of company or individual)
Contact Person's Full Name:
Contact Person's Phone Number:
Contact Person's Email:
Brief Description of the Project (Briefly describe the film/video's purpose and content. (e.g., Documentary about local artists, narrative short film, commercial for X product)):
When will the filming/recording take place? (Include specific dates or a range of dates):
Where will the filming/recording take place? (Be as specific as possible, e.g., "John Smith's house at 123 Main Street, Anytown" or "Various locations in Anytown Park")
Full Name:
Address:
Phone Number:
Email:
Age:
Parent/Guardian Full Name:
Parent/Guardian Address (If different from minor's):
Parent/Guardian Phone Number:
Parent/Guardian Email:
How will the participant appear in the film/video? (e.g., Interviewee, background extra, performing a specific task)
How will the footage be used? (e.g., In the film/video itself, promotional materials, online distribution, film festivals, educational purposes) Be very specific and list all intended uses.
Where will the film/video be shown/distributed? (e.g., Worldwide, specific countries, online only)
How long will the production company have the right to use the footage? (e.g., In perpetuity, for a specific number of years)
Will the participant receive any compensation for their appearance/contribution?
Type of compensation:
Compensation Amount:
Release of Liability:
Waiver of Moral Rights:
The participant has read and understands the terms of the release and agrees to them.
Participant, please sign here.
If Participant is a Minor, Parent/Guardian, please sign here.
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Important Considerations:
Strengths:
Areas for Improvement and Further Consideration:
Specificity is Key: While the form prompts for details, it's crucial to be as specific as possible in each section. Vague terms can lead to disputes. For example:
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