TALENT RELEASE FORM
PROGRAM TITLE: ________________________________________________________________ DATE: ________________________________________________________________________ In consideration of your plan to produce the above program and as an inducement to permit me personally to appear on the online broadcast of the video entry, I hereby consent to the use of my name, likeness, pictures and / or voice by you and the Wild Garden, direct exhibition and subsidiary purposes. I hereby indemnify you and Wild Garden respecting any claim or action against you, Wild Garden , or you or the officers and agents, arising out of my acts or statements on the program. SIGNED: __________________________________________________________________ ADDRESS: _________________________________________________________________ CITY: ________________________________________State: ______ZIP: ______________ PHONE: ______________________________ WITNESS: __________________________
I represent that I am the parent (or guardian) of:
_________________________________ (Print child’s name) _____________________________________ (Parent’s signature)
Who is a minor and that I authorize, approve and agree to the contract signed by him / her as stated above, and I agree that he / she and I will be bound by it.