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MUSIC RELEASE

for the
MORE THAN JUST MUD
MiNiFLiCK Contest

You must submit this form if someone has created original music or sounds for your film.

I _________________________________________ hereby authorize the use, in part or in whole,

of my musical compositions, sound recordings and/or performances, with credit given to me, for the

film __________________________________ made by _________________________________

for the Raincoast Education’s “More Than Just Mud” MiNiFLiCK Contest. Furthermore, I certify that

I have the right to authorize this use and that it does not require consent from any third party nor

violate the copyright of any other person or entity.

The following is a description of my musical materials (include title of music, composer, musician):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

I hereby authorize the Raincoast Education Society, its employees, representatives and assigns,

the right to use, reproduce, edit, publish or distribute my music and/or sounds in relation to the film,

in perpetuity, for the purposes of education and promotion, without compensation to me.

By contributing to this film, I voluntarily assume any and all risks. To the fullest extent allowed by

law, I waive any right to seek damages or compensation from the Raincoast Education Society or

filmmaker(s) as a result of my contribution to this film.
________________________________________ Date: _________________________________
(Signature)

_______________________________________
(Printed name)

E-mail: __________________________________ Phone: ________________________________

Address: _______________________________________________________________________

If Signatory is under 18:

I certify that I am the parent or guardian of the minor whose name appears above, that I have read,
understood, and approve of the conditions of this Release, and consent to its execution by my
child/ward. I hereby guarantee completely, my child’s/ward’s Release as set forth above.

________________________________________ Date: _________________________________
(Signature of Parent or Guardian)

_______________________________________ Phone: ________________________________
(Printed name)

Address: _______________________________________________________________________

This contest is sponsored by the Raincoast Education Society with
funding from the Habitat Conservation Trust Fund.