Release Form – [COPGF] Prairie Grass Film Challenge

Date

Team Name *

Team Director *

City, State

Select release type *Are you signing this release as an actor, location, or musician?

You are signing this release as an actor (Option 1 in the form below)

Filming Location

Use this field ONLY if you are signing this release for a physical location (Option 2 in the form below)

Song & Performer

Use this field ONLY if you are signing this release for a song & performer (Option 3 in the form below)

Agreement *

I hereby acknowledge that I am participating in a motion picture being produced by the aforementioned Team director (hereafter, Team Producer) as part of the 2020 Prairie Grass Film Challenge taking place January 16-18, 2020.

SHOOT RELEASE: I hereby irrevocably grant to the Team Producer, and to the Prairie Grass Film Challenge (dba Dordt College), its licensees, agents, successors and assigns, the right, but not the obligation, in perpetuity throughout the world and in all media, now or hereafter known, to use (in any manner it deems appropriate and without limitation) in and in connection with the motion picture, by whatever means exhibited, advertised or exploited:

1) my appearance in the motion picture, still photographs of me, recordings of my voice taken or made of me by it, any music sung or played by me, and my actual or fictitious name; and/or

2) the appearance of the location or property known as: (Location), of which I am the owner and/or manager with the power to so grant; and/or

3) the song or music, known as (Song & Performer), for which I have the authority to grant**.

**Use of song or music by the Team Producer and/or the Prairie Grass Film Challenge is strictly limited to the film/video referenced herein.

Furthermore, I acknowledge that Prairie Grass Productions/Dordt College, or its assigns, may shoot behind the scenes “making of the Prairie Grass Film Challenge” footage, for use in a motion picture, and I hereby irrevocably grant to Prairie Grass Productions/Dordt College, its licensees, agents, successors and assigns, the right, but not the obligation, in perpetuity throughout the world and in all media, now or hereafter known, to use (in any manner it deems appropriate and without limitation) in and in connection with the motion picture, by whatever means exhibited, advertised or exploited: my appearance in the motion picture, still photographs of me, recordings of my voice taken or made of me by it, any music sung or played by me, and my actual or fictitious name.

CORRESPONDENCE: I agree that PGFC may contact me occasionally via email to let me know about upcoming events or to correspond with me about the event or the organization that hosts the event.

LIMITED LIABILITY: Furthermore, I understand that during my participation in the Prairie Grass Film Challenge, I may be exposed to a variety of hazards and risks, foreseen and unforeseen, that may include, but are not limited to, personal injury, property damage, and death. To the fullest extent allowed by law, I agree to waive, discharge claims and release from liability the Prairie Grass Film Challenge, Prairie Grass Productions and Dordt College, its officers, directors, employees, agents and leaders from any and all liability on account of, or in any way resulting from injuries or damages. I understand and intend that this assumption of risk and release is binding upon my heirs, executors, administrators, and assigns, and includes any minors accompanying me on the Project.

First Name *

Last Name

Email Address *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone

Signature *

By checking this box, I am signing this document