Release form, Marissa Johnson

PERFORMER/CONTRIBUTER RELEASE FORM

Producer: Amber
Production Title: It's ok to be different.

1. In connection with my appearance in the above production I, _________________________________, HEREBY AGREE to the reproduction of the above DRAMA/COMMERCIAL/DOCUMENTARY/ARTWORK/OTHER (please state _________________________________) (delete as appropriate), as the same may be edited, modified or revised, containing my voice and/or likeness, in perpetuity throughout the world.

2. I HEREBY GRANT to the producer the perpetual worldwide right to use my name and/or likeness in respect to the advertising, publicizing and/or exhibition of the production.

3. I HEREBY AGREE that I, my agents, personal representatives, heirs, executors and any and all other parties acting through me or on my behalf will not make any claim, demand, action or suit of any kind or nature whosoever, including but not limited to claims of invasion of privacy, rights of publicity or other civil rights, or for any other reason whatsoever in connection with the rights granted by me hereunder.

Either:

4. I HEREBY CERTIFY and represent that I am 18 years of age or older, have read the foregoing Release and fully understand the meaning of the same and the consequences resulting therefrom.

Or:

5. I HEREBY CERTIFY that I am the legal guardian of the performer/contributor, have read the foregoing Release and fully understand the meaning of the same and the consequences resulting therefrom and grant my consent for the inclusion of the performer/contributor in the above mentioned production.


SIGNATURE: ___________Amber Keeton________________________

PRINT NAME: _______Amber Keeton____________________________

DATE: __________7/12/15_________________________