Fillable Printable Simple Actor Release Form

Simple Actor Release Form

ACTOR RELEASE

I (the undersigned) do hereby confirm the consent heretofore given you with respect to your

photographing me in connection with your motion picture/video:

Title

Production Number _________________________________________________________

and I hereby grant to you, your successors, assigns and licensees the perpetual right to use, as you

may desire, all video, still and motion pictures and sound track recordings and records which you

may make of me or of my voice, and the right to use my name or likeness in or in connection with

the exhibition, advertising, exploitation or any other use of such motion picture or recording.

I also understand that it takes a significant amount of time to complete a film – and in some cases

student films are abandoned and not completed at all. If the student filmmaker has promised a tape

of the film I agree to allow a reasonable amount of time to elapse after the performance for

completion (i.e. six months).

 I am over eighteen years of age

 I am a member of the Screen Actor’s Guild

Signature

Name (print) ____________________________________________________________

Address

Phone Number ___________________________________________________________

Character Name __________________________________________________________

PM/AD/ Student Filmmaker _____________________________ Phone

SFTV Class _________________________________________ Date _______________

8/05