Release Form for Media Recording

I, the undersigned, do hereby consent and agree that The Practitioner Youtube Channel,
its employees, or agents have the right to take photographs, videotape, or digital recordings of
me beginning on uly !", !#$% and ending on
uly !", !#$% and to use these in any and all media, no& or hereafter
kno&n, and e'clusively for the purpose of cosplay photographs or video and promoting the artform and
fandom( I further
consent that my name and identity may be revealed therein or by descriptive te't or
commentary(
I do hereby release to The Practitioner Youtube Channel, its agents, and employees all
rights to e'hibit this &ork in print and electronic form publicly or privately and to market and sell
copies( I &aive any rights, claims, or interest I may have to control the use of my identity or
likeness in &hatever media used(
I understand that there &ill be no financial or other remuneration for recording me, either for
initial or subse)uent transmission or playback(
I also understand that The Practitioner Youtube Channel is not responsible for any
e'pense or liability incurred as a result of my participation in this recording, including medical
e'penses due to any sickness or in*ury incurred as a result(
I have read the foregoing and understand its terms and stipulations and agree to all of them+
Model,s -ame .Please Print/
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.If the person signing is under age $3, a parent or legal guardian must sign belo&(/ I hereby certify that
I am the parent or legal guardian of the model named above and I give my consent &ithout reservation
to the foregoing on behalf of him or her(
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.1ignature of parent or guardian/