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FILM (WORKING TITLE): PRODUCTION DATE(S): PERSON APPEARING: _________________________________________________________ PRODUCTION LOCATION(S): Filming ORGANISER / PHOTOGRAPHER or RECORDIST NAMES and CONTACT DETAILS: Robyn Stanton-Humphreys (13PEH) and Shannon Darby-Jones (13PEH) Churchill Academy and Sixth Form.


I hereby give permission and authorise the producers and those authorised by the producers; Producers agents, successors, assigns and designees to record ,at the above EVENT, my name, image, voice, sound effects, interview and performance by photograph and/or video and/or film and/or sound recording (Recordings) and I agree that such Recordings may be edited and otherwise altered at the sole discretion of the producer and used in whole or in part for any and all broadcasting, non-broadcasting, audio/visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world. I agree that the Recordings may be used (transcribed or otherwise throughout the world for the full period of copyright, including all renewals, reversions, extensions and revivals of such period, in the following ways: (a) Store, publish or transmit the Recordings in internal archives and databases; (b) Copy, reproduce, digitise, broadcast, transmit, rent, lend, perform and exhibit the Recordings in internal archives and databases and communicate and make the recordings available to the public in all media, including but not limited to print, on DVD or other digital media and the Internet at the producers media websites and affiliated websites; (c) Exhibit, publish or transmit the Recordings in print, on DVD or other digital media and on the Internet at the producers media websites and affiliated websites; and (d) Distribute the Recordings to the press, media organisations and other interested parties for publication, transmission or broadcast. If I am making a presentation or delivering a lecture that is to be recorded, for UK copyright reasons I agree to use my best effort to ensure that any third party (i.e. others) copyright material that I show or play, for example, a photograph or illustration to be shown in a PowerPoint presentation or part of a musical work that will be played, will be used for the purposes of criticising or reviewing the material and not only for illustrative purposes. I allow the producer to remove any third party copyright material presented in my recorded presentation or lecture that the producer in its sole discretion believes is not used in such a manner and has insufficient permissions or copyright clearance from rights holders. For the avoidance of doubt, all rights of whatever nature (including copyright) throughout the world which I have in the original material in my presentation or lecture other than those I expressly grant the Producers under the licence in 1. In this Consent/Release Form are retained by me.


Signature_________________________________________________________ Address: _________________________________________________________ City: ____________________County: ___________________Postcode: ___________________ Telephone (landline or mobile): ________________________________________________________ Email: __________________________________________________Date: ____________________