Video Release Form

Omni Video Productions Televsion & Publishing

VIDEO SUBMISSION RELEASE

(Document must be signed by everyone who works on or appears in
(except for public crowd shots) a Submission and by the Producer(s))

“Producer”=___________________________________________________________________________________________
[Print name(s) of Person(s) creating and submitting a Submission only]

By signature below, each of the undersigned signifies his or her agreement as follows:

For good and valuable consideration, including the possibility of publicity, the receipt and sufficiency of which is hereby acknowledged, I hereby irrevocably grant to Producer all services and appearances rendered by me, and all ideas and materials provided by me, in connection with the development, production and/or exploitation of print, graphic, audio and/or visual or other content, projects, productions, campaigns and/or programs relating to Omni Video Productions. My services are a “work-for-hire” as that term is used in copyright law.

I hereby irrevocably give and grant to Producer all rights of every kind and character whatsoever in all media and languages now known or hereafter devised (including, but not limited to, film, television, videocassettes, interactive devices and Internet and on-line systems) throughout the world, in perpetuity, in and to all work done, and all poses, acts, plays and appearances made by me, my voice and instrumental, musical or other sound effects produced by me, and in and to all of the results and proceeds of my services as well as in and to the right to use my name, likeness and photographs, either still or moving, for all commercial and non-commercial purposes (including, but not limited to, merchandising, advertising and promotion purposes). Without limiting the foregoing, I further irrevocably give and grant to the Producer Parties the right to adapt, change, edit, modify, add to, delete, combine with other materials, record, reproduce, distribute and otherwise exploit the same by any means now known or hereafter devised. Producer and the Producer Parties may freely assign or transfer its rights hereunder, in whole or in part.

I hereby irrevocably agree that I will not assert nor maintain against the Producer, its licensees, successors or assigns, or any of their directors, officers, employees or representatives (“Producer Parties”), any claim, action, suit or demand of any kind or nature, whatsoever, including, but not limited to, those grounded upon invasion of privacy or of publicity or any other rights (including, without limitation, intellectual property rights), defamation, libel or slander or for any other reason in connection with the exercise of the rights granted herein. I realize that Producer is relying upon this Release in using me in the making of the Project and, accordingly, I hereby irrevocably waive any and all rights to seek or obtain any injunctive or other equitable relief against any of the Producer Parties. I further acknowledge and agree that any breach by me of this Release will cause Producer Parties irreparable harm, and therefore, that each of the Producer Parties will be entitled to injunctive or equitable relief (without the need to post bond or surety or show harm) in addition to all other remedies available at law or in equity, in any court of competent jurisdiction. The releases hereunder are intended to apply to all claims not known or suspected to exist with the intent of waiving the effect of Illinois Civil Code Section 1542 and other laws requiring the intent to release future unknown claims.

This Release will be governed by the laws of the State of Illinois applicable to agreements executed and to be fully performed therein (without regard to the conflict of laws provisions thereof).

No compensation will be paid hereunder.

1. Name:_______________________________________________________

Address:________________________________________________________

Phone Number:__________________________________________________
E-mail address:________________________________________
Age and Date of Birth:_____________________________
Worked on / Appears in Video: (circle one)
If appears in video, describe personal characteristics:_____________________________________________-
I have read and agree to the Omni Video Productions Submission Release.
Accepted And Agreed To By:__________________________ Dated as of:_____________________________
[Insert date of or prior service/appearance]____________________________
Signature: (Producer)________________________________________
Signature: (Person appearing / working / submitting)___________________________________________

[Signature indicates you have read and agree to the Omni Video Productions Submission Release.]

2.Name:_______________________________________________________

Address:________________________________________________________

[Signature indicates you have read and agree to the Omni Video Productions Submission Release.]

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3. Name:_______________________________________________________

Address:________________________________________________________

Phone Number:__________________________________________________

E-mail address:________________________________________
Age and Date of Birth:_____________________________
Worked on / Appears in Video: (circle one)
If appears in video, describe personal characteristics:_____________________________________________-
I have read and agree to the Omni Video Productions Submission Release.
Accepted And Agreed To By:__________________________ Dated as of:_____________________________
[Insert date of or prior service/appearance]____________________________
Signature: (Producer)________________________________________
Signature: (Person appearing / working / submitting)___________________________________________

[Signature indicates you have read and agree to the Omni Video Productions Submission Release.]

NOTE: If possible, obtain a copy of a driver’s license or other positive identification for each of the above listed people and attach hereto.
If any individual is under 18 years of age, the attached Parental Consent to this Release must be signed by a parent or legal guardian on
behalf of the minor. Document may be reproduced as needed.

IF A PERSON UNDER 18 YEARS OF AGE WORKS ON OR APPEARS IN THE SUBMISSION,

THE FOLLOWING MUST BE SIGNED BY A PARENT OR LEGAL GUARDIAN.

I am the father, mother or duly appointed guardian of the below noted child with full parental rights and authority, and I have read the Omni Video Productions Submission Release that my child has signed. I hereby consent to, join in and approve that agreement, will ensure that my child honors his/her obligations and will indemnify and hold Producer Parties (as defined therein) harmless against any and all claims or damages related in any way to the rights granted therein, my child’s performance or obligations thereunder, any breach of that agreement or any attempt to disaffirm that agreement.

Parent or Legal Guardian Name______________________________ Signature__________________________________-
Address:_________________________________________________________________________________________

E-mail address: ____________________________
Child’s Name _______________________________________Parent’s Phone Number____________________________
Corresponding Number on Release For Minor_________________________________________________-
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IF A PERSON UNDER 18 YEARS OF AGE WORKS ON OR APPEARS IN THE SUBMISSION,

THE FOLLOWING MUST BE SIGNED BY A PARENT OR LEGAL GUARDIAN.

Omni Video Productions SUBMISSION CLEARANCE REPORT
Tape Log
Identify by Time Code and Release # the first time each person depicted in the Submission appears, unless the person appears as incidental background or part of a crowd. (Also, make sure each person appearing in the video has signed the Release):
Name
Brief Description
Release #
Time Code
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Form may be reproduced, if necessary.

Omni Video Productions SUBMISSION CLEARANCE REPORT
Work Log
For each individual who worked on the Submission, identify the person and the corresponding Release # and list a brief description of all work performed: (e.g., camera operator, edited, wrote script, etc.)
Name
Brief Description
Release #
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Form may be reproduced, if necessary.
clearance_report.DOC