TRC News Media

Release Form – Interviewee Agreement

This Agreement is made as of the date indicated below between Filmmaker (defined below) and Performer
(defined below), as follows;

1. Interviewee agrees to render services as an on-camera performer in connection with the production of the
Video (defined below).
2. The term is in perpetuity, and the territory of the footage is worldwide.
3. Interviewee hereby grants to Filmmaker, its successors and assigns the right to use and display
Interviewee's likeness and performance as contained within the Video for any and all purposes and in any
and all media channels, now known or hereafter devised.
4. I hereby release Filmmaker, its successors and assigns from any and all claims, demands and liabilities of
any kind or nature whatsoever arising out of the aforementioned materials and the use thereof.
5. Filmmaker, its successors and assigns shall be the absolute owners of any and all photographs, film,
Video and other materials (and all rights therein, including the copyright) produced pursuant to this
release. Interviewee further agrees, subject to the provisions above, that Filmmaker may use Interviewee's
photograph, and/or likeness in any manner and with whatever copy they choose. Interviewee understands
that Filmmaker is not obligated to use Performer’s image.
6. Interviewee represents that by signing this Agreement and Release, Interviewee fully intends to be legally
bound to the terms stated within or, if Interviewee is under the age of 18 years, this Agreement and
Release is being signed by Interviewee's parent or legal guardian who represents his/her agreement to the
terms stated within and that Performer will be legally bound to such terms.
7. Interviewee's acknowledges that the production is non-union and holds the Filmmaker harmless for any
claims relating to hiring the Interviewee on that basis.


Date: ___13/12/13________________________________


Signature of Performer/Guardian ___________________________________

Print Name of Performer/Guardian ___________________________________

Character/Role __Sam Johnson_- Interviewee________________________________

Performer’s Email & Physical Address ___________________________________

Payment Amount (if applicable) ___________________________________


Signature of Filmmaker ___________________________________

Print Name of Filmmaker _____TRC News Media______________________________

Title of Video _TRC News Package__________________________________