Video Content Release Authorization

I hereby grant permission to the following organization/individual to record, use, reproduce, and distribute video footage that includes my image, likeness, and/or voice for the purposes stated below.

Full Name Date Address Name Purpose of Use Description of Video Content

I acknowledge that I will not receive compensation for the use of this video content. I hereby waive any right to inspect or approve the finished product where my likeness appears now or in the future, and I release the above organization/individual from any liability.