GraceTime and The GraceTime Contest requires permission from all
individuals in the movie produced ( minors by parents or legal
guardians) for all images and videos taken. Please
read
the “ Image and Video Release Form ” and sign at the end giving your
consent
1. Irrevocable License and
Release Re: Use of Motion Picture Product,
Image, and
Likeness
I attest that I am at least
eighteen years of
age and hereby authorize, permit, and license
GraceTime to
forever:
a. use,
promote, license, distribute, lend, display and publish my work in any
and all
media, as submitted to GraceTime (or the GraceTime Home Movie Contest)
and hereby
release them from all liability and claims that may arise out of the
exercise
of said authorization, permission, and license
b. use,
separately or together, my name, picture, image, or other likenesses in
any and
all present and future media for the purposes of advertising, publicity
and
trade related to material submitted to GraceTime (or the GraceTime
Movie
Contest). I understand that there will
be no financial or other remuneration for the use of my name, picture,
image,
or other likenesses and hereby release GraceTime
(or the GraceTime Movie Contest) from all liability and claims
resulting from
or connected with the publication of such work.
_________________________________________
______________________
Movie Title
date submitted
__________________________________________
______________________
name
birth date
______________________________________
___________________________
home or e-mail address
city,state & zip code
______________________________________
________________________
Applicant Signature
date
signed
I hereby attest that I
am at least
eighteen years of
age, have legal custody of ________________________, and consent to and
execute
on said minor's behalf the foregoing Irrevocable License and Release Re: Use of Motion Picture Product, Image, and
Likeness for the use and benefit of GraceTime (or the GraceTime Movie
Contest) and
do so knowingly and voluntarily. I
further release GraceTime (or the GraceTime Movie Contest) from all
liability
and claims that said minor has or may have that arise out of or relate
to the
execution and use by GraceTime (or the GraceTime Movie Contest) under
said
License.
___________________________________________________________________
Parent or Guardian name
please print
_________________________________________
_________________________
Parent or Guardian name signature
date signed
You
may download this document as a "rich text format (.rtf)"
at
http://www.gracetime.com/movie/gracetimeReleaseForm.html ..
.Fill in the
blanks and send via fax to Atten: GraceTime 413-793-0418 as
requested.