Media Release – Koa Aloha Media

Media Release Form & Limited Liability Release Form

Please Read and Acknowledge the Following for Participation in the below named project. *

I hereby acknowledge that I am participating in a motion picture named [Name in Form Below] being produced by Koa Aloha Media, (hereafter, Producer).

SHOOT/MODEL RELEASE: I hereby irrevocably grant to the Producer, its licensees, agents, successors and assigns, the right, but not the obligation, in perpetuity throughout the world and in all media, now or hereafter known, to use (in any manner it deems appropriate, and without limitation) in and in connection with the motion picture, by whatever means exhibited, advertised or exploited:

1) my appearance in the motion picture, still photographs of me, recordings of my voice taken or made of me by it, any music sung or played by me, and my actual or fictitious name.

I acknowledge that this agreement is for a payment of $0 for my participation and does not include deferred pay, motion picture ownership through points or percentages or additional monies to be paid through distribution of all known and future media, advertising, merchandising, or promoting.  If additional payments are agreed upon, they shall be agreed upon on a separate contract.

Use of appearance, and/or location, and/or song/music as noted above by the Producer and/or is strictly limited to the film/video referenced herein. Furthermore, I acknowledge that the Producer., or its assigns may shoot behind the scenes “making of ” footage, for use in a motion picture, and I hereby irrevocably grant to the Producer, its licensees, agents, successors and assigns, the right, but not the obligation, in perpetuity throughout the world and in all media, now or hereafter known, to use (in any manner it deems appropriate, and without limitation) in and in connection with the motion picture, by whatever means exhibited, advertised or exploited: my appearance in the motion picture, still photographs of me, recordings of my voice taken or made of me by it, any music sung or played by me, and my actual or fictitious name.

LIMITED LIABILITY: Furthermore, I understand that during my participation in the production, I may be exposed to a variety of hazards and risks, foreseen and unforeseen, that may include, but are not limited to, personal injury, property damage and death. To the fullest extent allowed by law, I agree to waive, discharge claims and release from liability the Producer, its officers, directors, employees, agents and leaders from any and all liability on account of, or in any way resulting from Injuries or Damages. I understand and intend that this assumption of risk and release is binding upon my heirs, executors, administrators and assigns, and includes any minors accompanying me on the Project.

Name of Project *

Please type your full legal name as a digital signature acknowledging that you have read and understood the terms of the above listed release.

DIGITAL SIGNATURE *

Please type your full legal name as a digital signature acknowledging that you have read and understood the terms of the above listed release.

Email *

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IMDB Listing (if available)

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Video Submission Download Link if Available

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