JLTV Video Release Form

Video Title (Please print Video Title, First Name and Last Name directly on DVD or VHS TAPE):

_____________________________________________________________

In consideration of the time and resources you expend in evaluating the videotape I am submitting to
you and/or which is owned by me and/or in which I appear (the "Videotape") for possible inclusion in
one or more programs on your television network and for other good and valuable consideration, the
receipt and adequacy of which are hereby acknowledged, I irrevocably grant to you, your affiliates,
licensees, successors and assignees all right, title and interest in and to the Videotape and each
element contained therein (including, without limitation, all copyrights), and the license and
permission to use the Videotape, or any portion thereof, and to use my name, voice and likeness, in
programs on your television networks or any other production in which the Videotape or any portion
or frame thereof might be included as an element (be it television, home video, the internet, print
media, any form of compilation, and/or in any and all media whether now known or hereafter devised)
(collectively a "Program"), throughout the universe, in perpetuity. I also agree that you may use the
Videotape and any portion thereof, and my name, voice, likeness and biographical information, to
publicize and promote a Program and/or your services and that you may sell, assign or license your
rights hereunder to any third party in your sole discretion and without providing any further
consideration to me.

I understand that I will not receive any monetary or other compensation if the Videotape is included in
a Program or otherwise used as authorized herein. Further, I understand that the Videotape may be
edited for any reason and in any manner (including without limitation for reasons of content,
presentation and time) and may, to the extent decided by you in your sole discretion, have sound
effects, music, host voiceovers and/or other elements added to the presentation, and that you may use,
adapt and modify the Videotape or any portion or element thereof and combine it with other materials
in a Program.

I hereby release, discharge and hold harmless you, your affiliates, your licensees, successors and
assignees, and any and all other person(s) or entity(es) from any and all claims that I may have at any
time by reason of any such use, exploitation or the exercise of any rights granted hereunder and/or
arising from a breach of my representations and warranties hereunder. I represent and warrant (i) that
prior to granting the rights in this document, I was the sole and exclusive owner of the videotape and
had the full right and authority to enter into this agreement and to grant the rights herein, (ii) that the
Videotape was shot with a non-professional home video camcorder, (iii) that I am not a member of the
Screen Actors Guild, the American Federation of Television and Radio Artists, the Directors Guild of
America, the Writers Guild of America, or any like theatrical, motion picture or television union or
guild. I hereby agree to indemnify and defend you against any and all losses, claims, debts, demands,
liabilities, attorneys' fee and all other damages or costs arising from or related to a breach of any of the
above representations or warranties or the falsity of any of these representations or warranties.

This Release will be governed by and construed in accordance with the laws of the State of California
applicable to contracts entered into and fully to be performed therein. I understand and am bound by
all terms contained in this Agreement. Further, I understand that (i) nothing shall require you to
include me or the Videotape in a Program or to broadcast or otherwise exhibit a Program, (ii) you
cannot be responsible for lost or misdirected tapes, (iii) the Videotape will become your property and
will not be returned to me, and (iv) you would not evaluate the Videotape without this Agreement and
that, should you include the Videotape or any portion thereof in a Program or exercise any other rights
granted hereunder, you will be doing so in reliance on this Agreement.
Signature: ______________________________________
Print Name:
______________________________________
Social Security #: _________________________________
Address:
_______________________________________________
_______________________________________________
_______________________________________________

Phone Number:
(Home) _________________________________________
(Work)
__________________________________________
TO BE COMPLETED IF PERSON APPEARING AND/OR WHOSE VOICE IS HEARD IN
THE VIDEOTAPE IS UNDER 18 YEARS OF AGE:

NAME OF CHILD: ______________

AGE: __________________

I represent and warrant that I am the parent or legal guardian of the minor child (the "Minor") whose
name appears above. The Minor and I, both individually, and I as the Minor's parent or legal guardian,
agree to be bound by all of the provisions of this Agreement.

Parent/Guardian:
Signature: ______________________________________
Print Name:
______________________________________

Address:
_______________________________________________
_______________________________________________
_______________________________________________

Phone Number:
(Home) _________________________________________
(Work)
__________________________________________