Video Footage Clearance and Release (TV Program) by Megadox


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Name of Videographer:

City / State (Prov) / Zip
(Postal) Code:
Participation in the submitted Filmmaker       _____        Interviewer _____
footage (check all that apply): Persona        _____        Musician    _____
                                Other (specify): ____________________________

In return for the opportunity for the video footage more particularly described in Schedule “A”
attached hereto (all or any part thereof referred to as “Footage”) to appear on
_______________________ [name of program] (the “Program”), I, the undersigned, hereby
grant to _________________ [name of channel/network] (the “Network”) and the producers of
the Program (the “Producers”) the right to broadcast, publish, reproduce, modify, display and
otherwise use the Footage, in whole or in part, and to use my name in connection therewith. I
further authorize the Producers to use excerpts of the Footage as used in the Program for the
purpose of promoting and publicizing the Program.

I hereby represent and warrant that I have the full right and authority to enter into this Agreement
and to grant the rights conferred hereunder, and that I hold all ownership rights in and to the
Footage (including all copyright thereto) or that I have obtained the written permission of any
other party who holds any such rights. I hereby assume all liabilities, damages, penalties, legal
fees, costs and expenses that may arise as a result of the illegal use of copyrighted materials in
the Footage.

I understand that I have the right to terminate this Clearance and revoke the rights granted
hereunder by _______ days’ written request to the Producers.

I understand and acknowledge that the Producers are under no obligation to use the Footage, in
whole or in part, in connection with the Program. I also understand and agree that the Footage
submitted to the Producers herewith cannot be returned to me, and that the Producers will
destroy any such Footage that they do not use for purposes of the Program.

I hereby waive any right that I may have to inspect or approve the finished product or the written
copy that might be used in connection with the Program, or to approve the use to which it may be

I agree to indemnify and hold harmless the Producers, the Network, and their respective
directors, officers, employees, agents, representatives, successors and assigns from any liability,
loss, claim, lawsuit, proceeding, cost or damage of any nature whatsoever arising from any use
of the Footage with respect to the Program.

This Clearance and Release shall be binding upon me and upon my heirs, personal
representatives and assigns.

I have read this Clearanc
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