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______________, 200_

_____________________ with offices at _________________________________________ (“Production


For good and valuable consideration, including the opportunity to appear in Production Company’s production, the
receipt and sufficiency of which is acknowledged, I hereby agree to the following:

Production Company has my permission to photograph, film/videotape me and record my voice, and to use those
photographs, film/videotape and recordings and any material I provide, and my name, voice, likeness, image and
information about me (collectively referred to as my “Performance”), for any purpose in connection with the motion
picture currently entitled _______________________________ (the “Picture”) and the advertising and promotion
thereof. I will indemnify and hold harmless Production Company and its assigns from and against all costs, damages
and claims arising from any breach or alleged breach by me of any representation, warranty or agreement hereunder.

Production Company is under no obligation to utilize my Performance or the results and proceeds thereof. My
Performance in connection with the Picture shall be deemed work-made-for-hire specifically ordered or
commissioned by Production Company under all applicable copyright laws. Production Company shall exclusively
own all now known and/or hereafter existing rights of every kind throughout the universe, in perpetuity and in all
languages, pertaining to such results and proceeds in and to my Performance and the Picture, and all elements therein,
for all now known and/or hereafter existing uses, media, and forms, including, without limitation, all copyrights. If
any of the work product hereunder is determined to not be a work-made-for-hire, I hereby assign to Production
Company in perpetuity all right, title and interest in and to such work product, including without limitation, all
copyrights in my Performance (and all renewals and extensions thereof). Notwithstanding anything to the contrary
contained in this agreement, I agree that Production Company shall have the unlimited right to edit, rearrange, vary,
change, alter, modify, and to, and delete from my Performance. I hereby waive the benefits of any provision of law
known as “droit moral” and/or “moral rights” or any similar law in any jurisdiction of the universe and hereby agrees
not to institute or support, maintain, or permit any action or lawsuit on the grounds that the Picture or any other film
and/or soundtrack and/or any other ancillary, subsidiary, related or other product produced or exploited by Production
Company violates any of my rights or is in any way a defamation or mutilation of the product of my Performance.

I understand that Production Company may assign the rights and/or extend this permission to third parties, in
Production Company’s sole discretion, in connection with any of the permitted uses indicated above, and I understand
that Production Company and those others will be relying on and incurring certain expenses based on my having
given Production Company this permission. I acknowledge that, other than as stated herein, Production Company has
not said or promised anything to induce me to grant Production Company this permission. This permission, and all the
rights granted to Production Company, are irrevocable and not subject to rescission, revocation or termination. I
further understand and agree that under no circumstance shall I be entitled to equitable and/or injunctive relief in
connection with this release and/or the Picture. This agreement shall be interpreted in accordance with the laws of the
State of California, applicable to agreements executed and to be wholly performed therein. The Parties agree and
consent that the jurisdiction and venue of all matters relating to this agreement will be vested exclusively in the
federal, state and local courts within the State of California, Los Angeles County.

______________________________ _________________________________
(Print Name) (If Minor, Parent or Legal Guardian)