WAIVER OF LIABILITY AND

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					                                         WAIVER OF LIABILITY AND
                                        MEDIA RELEASE AGREEMENT

IN CONSIDERATION for being permitted to participate in activities of the Eco Effect TV Show, THE
UNDERSIGNED, for himself/herself, my personal representatives, heirs and next of kin:

         I, (full name)____________________________________________________ as an associate or

representative of ________________________________________________________ (company/self)

on this (date)___________________________________, do hereby grant permission to Eco Effect TV Show to use
images, audio and recordings for such use including but not limited to display, broadcast, distribution, publication,
transmission, or otherwise use of recordings for use in materials that include, but may not be limited to, printed
materials such as television, newsletters, videos, and digital images, social media such as those on the Eco Effect TV
and affiliate web sites.

        I grant unrestricted permission my image and video recordings of myself and my property to be used in
broadcast, print, video, and digital media. _______(initial)

          I understand and agree that these recordings may be used by Eco Effect TV for a variety of purposes and
that these recordings may be used without further notifying me. _______(initial)

         I understand and agree that my first name and last name, city and zip code WILL BE used in conjunction
with any video or digital images on Eco Effect TV Show and affiliate web sites. _______(initial)

         I agree that I assume the risk of injury during my participation in the recording and I agree that my
participation in the recording acknowledges that I find the film site as being reasonably safe for the purpose of my
use, and further I agree that if, at any time I feel anything to be unsafe, I will immediately withdraw from the
dangerous area; _______(initial)

          I acknowledge that in the course of my participation in the Eco Effect TV recordings, video or photographs
may be taken or illustrations may be made of myself and further I agree to allow, without compensation, my
likeness to appear in material, regardless of media form, promoting the recording, its events and activities, including
those of its representatives, affiliates and licensees; _______(initial)

          I agree that the foregoing release, waiver and agreement is intended to be as broad and inclusive as is
permitted by laws of the State of Hawaii and the United States of America and that if any portion thereof is held
invalid, the balance shall continue in full legal force and effect. _______(initial)

        I have read and voluntarily signed this Waiver of Liability and Media Release Agreement and further
guarantee that no additional oral representations, statements or inducements have been made. _______(initial)

				
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posted:9/22/2012
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