Date:
Name:
Address:
Date Birth (if minor need parents consent):_________ Social Security Number:
I understand that The Valhalla Movement Foundation dba as Valhalla Movement or its affiliates (the “Producer”) is producing an audiovisual production, video or film presently entitled “_______________” (the “Project”) and that Producer has requested that I grant it the right to photograph and record me, my voice, and/or use existing footage of myself for inclusion in the Project.
I hereby agree to the photographing, recording, publication, broadcasting, transmission and reproduction of my name, appearance, image, likeness, voice and other participation in the Project and hereby confirm my agreement and consent to participate in the Project. I hereby grant to Producer, its agents, assigns, employees, licensees and successors all of my right, title and interest in and to the Project, including, without limitation, the right to use footage of myself and recordings of my voice (such photographs and recordings to be collectively referred to as the “Reproductions”) in connection with the Project and to include in the Project any of the Reproductions. I acknowledge that Producer is and will be the sole owner of all rights, including copyright, in and to the Reproductions, any contributions made by me, the Project and any recordings, works and reproductions thereof.
I agree that Producer may record any of the Reproductions in any format or media now known or hereafter developed for use in the advertising, exhibition, exploitation, promotion, exploitation, transmission, distribution and turning to account all or any part of the Project as Producer may, in its sole discretion, determine, including by theatrical, television, home video, interactive, web, internet or mobile and any other medias now known or hereafter discovered.
I understand that Producer is under no obligation to use the Reproductions in connection with the Project and that Producer shall have the right to edit, modify, add to and delete any material, juxtapose, change the Reproductions including any sequence of events, questions asked and answers, fictionalize persons or events including the undersigned and makes changes to the Reproductions and the Project including dub, substitute the voice of another person for my voice and that Producer may use my name, image, voice and likeness and other information concerning me in connection with the Project, the whole as Producer may, in its sole discretion, determine.
I hereby expressly release Producer, its agents, assigns, employees, licensees and successors from and against any and all claims, liabilities, demands, actions, causes of action, cost and expenses, whether at law or in equity, which I have or may in future have for invasion of privacy, appropriation of personality, defamation, or any other cause of action arising out of the exploitation of the Project or any part thereof. I agree to hold Producer, its agents, assigns, employees, licensees and successors harmless against any liability, loss or damage cause by or arising from my participation in the Project.
I acknowledge that Producer is relying upon the rights granted to it hereunder in incurring the costs of producing the Reproductions.
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(Signature of Person giving the consent)
Print Name: