Extra Waiver and Release

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									Extra Waiver and Release
This is a document that can be used to obtain a legal waiver from an extra in a
television show, a featured film, a music video, or any other video production. Obtaining
waivers from extras is vital to ensure that the production company legally uses the
images and likeness of the individual. Customize the production name, the production
type, the date of the production, and much more. This document can be used by
individuals or small businesses that are producing a film, show, or music video and want
to legally obtain the right to use the images and likeness of extras.
   ______________________ [Instructions: Insert the name of the Production Company]
 ______________________ [Instructions: Insert the address of Production Company line 1]
 ______________________ [Instructions: Insert the address of Production Company line 2]

                                 EXTRA WAIVER AND RELEASE
[Comment and Instructions: Choose one. If you are paying the extra choose the 1st option, if
not, choose the 2nd option.] [For the sum of _____________ Dollars ($____) [Instructions:
Insert Fee Amount], and other good and valuable consideration, the receipt, adequacy and
sufficiency of which is hereby acknowledged,] OR [For good and valuable consideration, the
receipt and sufficiency of which is hereby acknowledged,] I, the undersigned, as of
______________________ [Instructions: Insert the date of this release], hereby execute this
Extra Waiver and Release (the “Waiver and Release”) to document my agreement to participate
in the filming of the _____________ [Instructions: Insert the type of Project this agreement
pertains to, e.g., television show, featured film, etc.] titled “______________________”
[Instructions: Insert the title of the Project] (hereinafter referred to as the “Project”) by
______________________ [Instructions: Insert the name of the Production Company]
(hereinafter referred to as the “Producer”) in or around ______________________
[Instructions: Insert the location of the filming of the Project] on or about
______________________ [Instructions: Insert the date of the filming of the Project] upon
the terms and conditions set forth herein.

1.       AUTHORIZATION

I hereby irrevocably and unconditionally grant to Producer, and its subsidiaries, successors, and
assignees, and those acting under their permission or upon their authority, the right to video and
audio tape my name, likeness, image, voice, appearance and performance, in connection with the
filming of the Project and the production of the Project and I irrevocably and unconditionally
grant to Producer the unrestricted, unfettered and perpetual right to distribute, broadcast and
transmit my name, likeness, image, voice, appearance and performance in connection with the
dissemination and distribution of the Project and all Project footage through any media format as
the Producer, in its exclusive discretion, deems appropriate.

2.       OWNERSHIP

I hereby agree that the Producer shall be the exclusive owner of all rights, including but not
limited to all copyrights, titles and interests, throughout the universe and in perpetuity relating to
the Project, including but not limited to all video, footage and all artistic and creative elements
related thereto or incorporated therein and I hereby assign any and all right, title and interest I
may have in, any prints, negatives, videotape and elements thereof made in connection therewith
to the Producer, along with full rights of assignability.

3.       ASSUMPTION OF RISK

I acknowledge that my participation in the Project may present certain risks to me, and I
knowingly, willingly and voluntarily assume any and all risks associated therewith, whether
known or unknown, foreseeable or unforeseeable, specifically including but without limitation,
the risk of physical or mental or emotional injury, minor and/or severe bodily harm, and/or


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illness, which arise by any means, including, without limitation: acts, omissions,
recommendations or advice given by the Producer or its agents, employees, or other persons or
entities affiliated with the Project; participation in inherently dangerous activities, latent or
apparent defects or conditions in any equipment used in the Project; weather or other natural
conditions; human error; my physical and mental condition; my own acts or omissions; first-aid,
emergency treatment or other services rendered to me or others.

4.       RELEASE

I knowingly, willingly and voluntarily release, discharge and relinquish any and all claims,
actions and lawsuits of any kind against the Producer, and its related and affiliated companies,
licensees, sponsors, successors and assigns, and its employees, agents, contractors, partners,
representatives and members, related to or arising from my participation in the Project,
including, without limitation, travel to and from any location used in connection with the Project,
the making, taping, production, use, editing, distribution, licensing, promoting, and/or exhibition
of the Project, as well as any claims based on any use of name, likeness, image, voice,
appearance and performance and any rights that I might have to inspect or approve any finished
product or any advertising copy that may be used in connection therewith or the use to which it is
applied.

5.       REPRESENTATION AND WARRANTY

I hereby represent and warrant that I have the right to make this Waiver and Release and that my
granting this Waiver and Release and the rights conveyed herein will not infringe the rights of
any third party.

6.       INDEMNIFICATION

I agree to indemnify and to forever hold harmless the Producer, its agents, employees, or other
persons or entities affiliated with the Project, against loss, including attorney’s fees and costs,
from any claim or demand of every kind and character which may be asserted by any party by
reason of my participation in the Project or my breach of any covenant or representation herein
contained.

7.       INFORMED CONSENT

I have read this Waiver and Release prior to signing and I understand its contents. I understand
that the Producer will incur substantial expense in relying upon this Waiver and Release. I am at
least eighteen (18) years of age, or, if under eighteen (18) years of age, my parent or guardian
has executed the below Minor Consent and Release Authorization.


         Signature: _______________________________

         Print Name: __________________________________




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         Social Security Number: ________________________

         Date: __________________________________




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                                    MINOR CONSENT AND RELEASE

I represent and warrant that I am the parent or guardian of the minor whose name appears above,
I acknowledge that I have read the foregoing Waiver and Release and am familiar with each and
all of the terms contained therein, I am satisfied that the Waiver and Release is fair and equitable,
and I hereby give my express consent to its execution by my child/ward and will not revoke my
consent at any time. I hereby release the Producer, and its related and affiliated companies,
licensees, sponsors, successors and assigns, and its employees, agents, contractors, partners,
representatives and members from any claims and/or causes of action I may have against them of
any nature whatsoever. I hereby fully and unconditionally guarantee the performance of my
child's/ward’s obligations and the grant of rights in and to the results and proceeds of my
child's/ward’s activities as set forth above.


         Signature of Parent/Guardian: _______________________________

         Print Name: ___________________________________

         Social Security Number: ___________________________

         Date: __________________________________




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