Whereas, the parties hereto, [name of Producer/Filmmaker] and any and all of their representatives, including photographers, video camera persons, or other employees or independent contractors, hereinafter referred to as Producer, and


Hereinafter referred to as Model/Actor, desire to enter into an agreement regarding the release of any and all rights by the Model/Actor and to grant to the Producer the right to use said videotape or other visual materials, the parties hereby intend to be legally bound and agree as follows:

1. I, 

for valuable consideration of


hereby give the Producer the rights and permission, with respect to the videotape or DVD or other visual materials they have taken of me or in which I may be included with others.

2. Model/Actor hereby grants to the Producer the right to copyright said videotape or DVD or other visual materials in the Producer’s name or any other name that the Producer may choose. The Producer is hereby granted the right to use, and re-use, said videotape or DVD or other visual materials in whole or in part, individually or in conjunction with other visual materials in their videos or DVDs or other vehicles of distribution, and for purposes of illustration, promotion, advertising and trade.

3. Model/Actor hereby grants the right to the Producer to use her/his name in connection with the materials and to use any biographical information therewith if the Producer so chooses.

4. Model/Actor hereby represents that s/he is over the age of 18 and has read this agreement and understands its content. Said Model/Actor hereby represents that s/he has been given the right and encouraged to have this agreement reviewed by his/her attorney.

5. Model/Actor hereby releases and discharges the Producer or any of their employees or representatives from any and all claims and demands arising out of or in connection with the use of the videotapes or DVDs or other visual materials, including any and all claims for libel.

6. Model/Actor hereby warrants that s/he has not assigned any rights in said videotape or DVD or other visual materials, or any personal property rights to said materials which would in any way interfere with this contract or with any of the other rights granted in this contract to the Producer, or has sold or granted any other rights to any other parties. The Producer, by this warranty, is granted the exclusive and sole reproduction rights, viewing rights, screening rights, and all other rights which may exist in any form now or in the future to said videotape or DVD or other visual materials.









  1. A photocopy of your identification. This ID must have your picture and must be current. Examples of a photo ID are driver’s license, passport or other photo ID that has your birth date on it.

  2. A second piece of photocopied identification. This does not have to have your picture. It might be a birth certificate, passport or other ID.

  3. Your signature written on the photocopies as well.

  4. A list of all other names you have used in any video or DVD (not just this one) that you have used in the last 5 (five) years.

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