Valencia College

Release & Assignment Agreement

I hereby grant to Valencia College, of Orlando, Florida and its designees or assignees: (a)
all right, title and interest, present and future, to scripts,, music, sets, designs, vocal or
instrumental sounds or personal appearances made by me for or in said production; (b)
and I further grant to Valencia College the unconditional right to “double” or “dub” my
voice, acts, poses, plays and appearances, and all instrumental musical and/or other
sound effects produced by me to such extent as Valencia College or its designees or
assignees may desire and (c) I further grant to Valencia College or its designees or
assignees the unconditional right to use my name, photography, likeness, acts, poses,
voice, plays and appearances made in connection with said production in any manner;
and to reproduce, publish, distribute, exhibit and transmit the same by any mechanical
or electronic means now known or to be created in the future, for use anywhere in the
world in any medium in perpetuity.

Name (Printed): ________________________________________________________________

Signature: _____________________________________ Date:__________________________

Address: ______________________________________ Phone: _______________________

Email Address: ________________________________________________________________

Witness: __________________________________________
Valencia College Representative

For Parent or Guardian of Minor Children

On behalf of myself/my child, _____________________________, I hereby grant to Valencia

Community College all the rights and entitlements stated above.

My child/children’s name(s) can/cannot be used in this production.

________________________________
Signature of Parent/Guardian

An Equal Opportunity Employer Revised: 7-06-2012