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Name of Production…… ……………………………………………………………….
Name of
Production Company/Organiser (“the Organiser”)
………………………………………………………………………………………………………
Description
of Involvement ……………………………………………………………………
……………………………………………………………………………………………………….
Date of
Filming ................................................................................................................
Name of
Contributor ……………………………………………………………………………
Address of
Contributor …………………………………………………………………………
……………………………………………………………………………………………………….
Contact
Number of Contributor ………………………………………………………………
In consideration of the Organiser agreeing
that I contribute to and/or participate in the MUSIC VIDEO, the nature and the
content of which has been fully explained to me, I consent to the filming and
recording of my contribution to and/or participation in the Film subject to the
terms and conditions specified below.
Signed by
Contributor …………………………………………………………………………..
Dated………………………………………………………………………………………………..
If the Contributor is 18 or under this form
must be signed by a Parent or Legal Guardian.
I consent to [name of Contributor] entering
into this agreement.
Signed by
Parent or Legal Guardian ...............................................................................
Dated ....................................................................................................................................
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