VIDEO APPEARANCE RELEASE

I hereby grant permission to [Company Name] and its affiliates, licensees, and assigns ("Company") to record my physical likeness and/or voice on video, audio, photographic, digital, electronic or any other media.

I understand and agree that Company may edit, modify, or prepare derivative works based upon the recording(s), in Company's sole discretion. Company shall own all rights, title and interests in and to such recording(s) and derivative works, including copyrights.

Company shall have the right to use, publish, reproduce, distribute, display, exhibit, broadcast, transmit, stream and otherwise exploit the recording(s) and derivative works, in whole or in part, in any manner or medium, whether now known or later developed, for any legal purpose whatsoever, including but not limited to promotional, advertising, marketing, packaging, instructional, educational or trade purposes.

I hereby waive any right to inspect or approve the recording(s), sound tracks, printed matter or derivative works that may be used in connection with them or any use to which they may be applied.

I release Company from any claims based on the use, publication, reproduction, distribution, display, exhibition, broadcast, transmission, streaming or other exploitation of the recording(s) or derivative works, including any blurring, distortion, alteration, optical illusion or use in composite form.

This release is binding upon me and my heirs, executors, administrators and assigns.

I am at least 18 years of age and have read the foregoing and fully understand its contents.

Agreed and Accepted

Name
Signature
Date