Interviewee and Film Extra Video Release Form

Interviewee and Film Extra Video Release Form
Please complete all sections below to provide your details and grant permission for the use of your recorded image and voice in video content. This form is required for participation.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Project or Production Name
Date of Filming
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your Role or Participation
Please specify if you selected 'Other'
Release and Permission Agreement
Signature – I confirm my consent and release for use of my recorded image and voice in video content.
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