ACTOR RELEASE FORM 2018

ACTOR RELEASE FORM:

Title of Production: _____________________________________________________
Director: _____________________________________________________________
Producer: ____________________________________________________________

ACTOR NAME: __________________________________________________________

ACTOR AGE: ___________________________________________________________

EMAIL ADRESS: _________________________________________________________

PHONE: ________________________________________________________________

o I confirm that I give Aimee Squire the right to film, photograph and record myself. This
includes my image, voice and performance.

o I confirm that I give Aimee Squire Permission to use video and audio footage of myself in her
production.

o I confirm that I give Aimee Squire the right to publish video and/or audio footage of myself
online in connection to the advertising and publicising of the production.

o I confirm that I give Aimee Squire the right to share video and/or audio footage of myself with
the UAL Exam Board, and students, teachers and parents at The Henley College.

o I confirm that I am aware that this production may be used in the future as work in a portfolio
that may be viewed by potential employers.

o I confirm that I am aware this film may be entered into Film Festivals and Competitions and I
give permission for my image, voice and performance to be shared.

o I confirm that my participation in this production is entirely voluntary, and I will not receive any
financial benefits from taking part.
o I confirm that I will work to the best of my ability in this production, and I will adhere to the
production schedule as strictly as possible.

SIGNED: __________________________________________________________________

DIRECTOR/PRODUCER: _____________________________________________________