Extra Release Form
Complete this form to authorize an extra release and specify the related permissions, restrictions, and terms.
Your Full Name (Releasor)
*
First Name
Last Name
Full Name of Releasee
*
First Name
Last Name
Describe what is being released
*
Permissions Granted
*
Use for commercial purposes
Modify or adapt
Distribute to third parties
Display publicly
Other
Are there any restrictions?
*
No restrictions
Limited use only
Cannot be transferred to others
Other
Is there any compensation involved?
*
No compensation
One-time payment
Ongoing royalties
Other
Effective Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Duration or Expiry (if applicable)
*
No expiry (perpetual)
Expires on a specific date
Other
Release Acknowledgment: I confirm that I am authorized to grant this release, have read and understood the terms above, and agree to the permissions and restrictions stated.
*
I acknowledge and accept
Signature
*
Submit Release
Submit Release
Should be Empty: