Every person seen or heard on the video must sign an individual release.
(If not eighteen years of age or over, this document must be signed by a parent or guardian).

STUDENT TEAM LEADER INFO

NAME:

PHONE:

EMAIL 1:

EMAIL 2:
(Other Team Member)

RELEASE

I hereby agree, in connection with my appearance in film/tape footage or my performance on audio track being produced by and/or for person named below, to the reproduction and use of such footage and/or audio track in a commercial which may be edited, modified and revised, containing my performance and/or voice and/or likeness, for the purpose of advertising and trade in any and all media anywhere in the world at any time without limitation.

I hereby grant to Courageous Persuaders and/or McCann Erickson the right to use my performance and/or voice and/or likeness for the purposes of advertising and trade at any time throughout the world in connection with the advertising and/or publicizing and/or use of such commercial in any and all media.

I hereby certify that I am eighteen years of age or over.

Print Name of Performer

Date(s) Services Rendered (When you filmed/recorded)

Signature of Performer

Signature of Parent or Guardian (*If necessary)

Street Address

City, State, Zip

Phone Number

Email