Performer Release Form
Name and Address of Company (on letterhead)
Or producer/ director personal address
Name and address of Contributor:
The Name of the Film (working title)
I agree to the inclusion of my contribution in this film, the explicit nature of which has been
explained to me. I understand that this film is designed to explore the line between art and
pornography and I can declare that I am comfortable with the project. I understand that my
contribution will be edited and there is no guarantee that my contribution will appear in the final
film. I agree that my contribution may be used to publicise the documentary.
I have agreed to accept a fee of £100.00 for the use of my contribution. This fee is payable on
completion of the filming.
I understand that this film (or part of it) may be distributed in any medium in any part of the
I can confirm that I am over 18 years of age and have provided my passport as proof.