Growing Up Chico Model Release

If you are submitting to the documentary film “Growing Up Chico,” the following model release is required for your participation.

Each person must submit their own release form.

After completing the release, you can upload your video footage here.

Please complete the model release below.

Growing Up Chico Model Release Form

Name of Project *

If the name of project is different than above, please list the project you are involved with.

FULL NAME *

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

NAME TO BE LISTED IN CREDITS (If different from above) *

Please tell us how you would like your name listed in the credits if different from you legal name.

Email *

Please Enter your address and we will send you a copy of the release.

IMDB Listing (if available)

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Additional Terms (if any)

Please Enter your Mailing Address Below *

Additional Info

Participation, Release, Limited Liability in The Horror We Make *

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

TERMS OF AGREEMENT FOR SHOOT/MODEL RELEASE/LOCATION USE/PROPERTY USE: 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, unless noted and agreed to by both parties and noted in the "applicable terms" below, 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.

I have read, understood and acknowledge the terms of participation, the model release, and limited liability as noted above.

Yes

Do not continue if you disagree.

I understand that: My participation is voluntary, I will not receive financial compensation, the Producer has full editorial control over how my interview is used, the Project may be distributed publicly and commercially; and I release and discharge the Producer and Koa Aloha Media from any claims arising from the use of my participation, including but not limited to claims for defamation, invasion of privacy, or right of publicity.

Yes

Do not continue if you disagree.

I agree to not post or share, on any media, any on-set footage images, set photos, cast photos, behind the scenes images, or still photos of the production of the project without written consent from Brian Barsuglia.

Yes

Do not continue if you disagree.

Signature

Clear

If you are human, leave this field blank.

Growing Up Chico Model Release Form

Filled out the release? Upload Here!