Fillable Printable Film/Movie/Sound Track Release Form

Film/Movie/Sound Track Release Form

FILM/MOVIE/ SOUND TRACK R EL EASE FORM

I, _____________ ______________ (COMPOSER), who com pose d and own t he

_________________________________

agree to allow ___________________________ (PRODUCER/FILMMA K ER), to

use my work in the production ent itled ___________ _________________

(FILM) . I, t h e COMP OSER, own the sole and legal copyright to the described

work, and hereby agree to the use of this work in the promotion, production and

distribution of the FILM, for the purposes of t he Street Grin d .

I am 18 years or over... .. . Y / N......( indicat e ch oice by circling)

Composer ______ ___________________________ __________________

Address_____________________________________________________

Telephone _________ ______ ____________________________________

Composer’s signature___________________________________________

Producer/Filmmaker_____________________________________________

Producer/Filmmaker’s Signatur e ___________________________________

Date_______________

A separate copy of this form to be completed by each musician/singer

Music Release Form

I hereby acknowledge my participation in the submitted movie, show, video or website

__________________Minute 5:15

Name/Title of Progr am

_________________________________

I hereby authorize you to use my film/movie/music/video as heard within the program

and grant all rights to said production owner to use such recordings, in whole or in part

for submission to the "Minute 5:15". I also acknowledge that all

film/movie/musical/video content is origi n al in natur e and I own the sole and legal

production and distribution purposes.

I certify and guarantee that I am at least 18 years of age or older.

You may also use my name, and/or biography for publicity, promotion, production and

distribution as deemed necessary.

__________________________________________________

Produced by

__________________________________________________

Signature of musician/singer

__________________________________________________

(Please print music performers full name here)

__________________________________________________

Your name and music title to appear in the credits

__________________________________________________

Address

__________________________________________________

City, State, Country, Zip

__________________________________________________

Telephone

__________________________________________________

Fax

__________________________________________________

Website

__________________________________________________

Date

PHOTOGRAPHY/VIDEO RELEASE FORM

To Whom It May Concern:

I (the undersigned) do hereby con f ir m the consent heretof or e given you with

respect t o your photographing me or my child in connection with your

video/telev ision program entitled Minute 5:15

________________________________________________________________

___________, and I hereby grant t o yo u, your succe sso r, assigns and licensees

the perpetual r ight t o use, as yo u may desire, all motion pictur es and so und t rack

recordings which you may make of me or my child, and the right to use my name

and/or child’s name or likeness in or in connection with the exhibition or any other

use of such video or r ecording.

I am over eighteen year s of age. Y/N

Please circle one.

Signature: _______________________________________________________

Name (print): _________________________________________________ ___

Name of Child: ______________ ___________________________ __________

(print)

Home Address: ________________________________ ___________________

________________________________________________________________

Phone Num ber (s):

________________________________________________________________

Date: ______________________ ___________________________ __________