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Talent Release Form
Author: Brenda Greenberg (UNITED STATES OF AMERICA) TALENT RELEASE NORTHERN SERVICES GROUP, INC.
Volunteer's Name (Print)________________________________________
Age (check one): Over 18 Under 18 ___
Legal Guardian (Print)__________________________________________ RELEASE
The undersigned individual hereby grants to the above named organization and its successors, licensees and assigns, the right to use the undersigned's name, likeness, voice, biography and history, under a real or fictitious name, in connection with the production, distribution and exploitation of the Program, and of any elements of the Program. Such grant includes use in advertising in connection with the foregoing, and use in any and all media, whether now existing or hereafter devised, throughout the universe.
The undersigned individual:1) agrees not to bring any action or claim against the agency or its successors, licensees and assigns, or to allow others to bring such an action or claim, based on the Program or the depiction of the undersigned in the Program or the use of material relating to the undersigned in the program or as otherwise described above, and (2) releases the agency its successors, licensees and assigns from any and all such actions or claims which the undersigned may have now or in the future.
The undersigned warrants that the use of the rights granted hereunder and any material supplied by the undersigned will not violate the rights of any third party.
SIGNATURE AND DATE Signature:________________________________________
Legal Guardian:____________________________________
Date:________________
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