MINOR APPERANCE RELEASE

FILM (WORKING TITLE): _________________________________________________________ PRODUCTION DATE(S):__________________________________________________________ PERSON APPEARING: __________________________________________________________ PARENT or GUARDIAN: __________________________________________________________ PRODUCTION LOCATION(S): __________________________________________________________ Filming ORGANISER / PHOTOGRAPHER or RECORDIST NAMES and CONTACT DETAILS: Robyn Stanton-Humphreys (13PEH) and Shannon Darby-Jones (13PEH) Churchill Academy and Sixth Form.

1.

As parent or guardian I hereby give permission and authorise the producers and those authorised by the producers; Producers agents, successors, assigns and designees to record ,at the above EVENT, my name, image, voice, sound effects, interview and performance by photograph and/or video and/or film and/or sound recording (Recordings) and I agree that such Recordings may be edited and otherwise altered at the sole discretion of the producer and used in whole or in part for any and all broadcasting, non-broadcasting, audio/visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world. I agree that the Recordings may be used (transcribed or otherwise throughout the world for the full period of copyright, including all renewals, reversions, extensions and revivals of such period, in the following ways: (a) Store, publish or transmit the Recordings in internal archives and databases; (b) Copy, reproduce, digitise, broadcast, transmit, rent, lend, perform and exhibit the Recordings in internal archives and databases and communicate and make the recordings available to the public in all media, including but not limited to print, on DVD or other digital media and the Internet at the producers media websites and affiliated websites; (c) Exhibit, publish or transmit the Recordings in print, on DVD or other digital media and on the Internet at the producers media websites and affiliated websites; and (d) Distribute the Recordings to the press, media organisations and other interested parties for publication, transmission or broadcast.

I represent, as parent or guardian of__________________________, we shall both be bound by the terms of this Appearance Release. Signature of Minor: _________________Signature of Parent or Guardian:__________________ Address: __________________________________________________________ City: __________________________County: __________________________Postcode: __________ Telephone (landline or mobile): ________________________________________________________ Email: __________________________________________________________Date: ______________