I, the unsigned, do hereby consent and agree that HouseHeads magazine, uts employees, or agents have the right

to tale photographs, videotape or digital recording of me beginning on _______________ and ending on ______________ And to use these in all media, now or hereafter known, and exclusively for the purpose of HouseHeads magazine in which medial will be used for website purposes and the front cover, contents page and double page spread. I further consent that my name and identitly may be revealed or changed there in or descriptive text or commentary. I do hereby release HouseHeads magazine, its agents and employees all right to exhibit this work in print and electronic form (Yola Website) publicly or privately and to market and seel copies. I waive any rights, claims or interest I may have to control the use of my identitly or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either initial or subsequent transmission or play back. I also understand that HouseHeads magazine is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result. I have read and understood the foregoing statement and am competent to execute this agreement. Name:________________________________________ Date:_________________________________________ Witness for the undersigned: __________________________________________________ Signature:_________________________________________