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AUTHORIZATION TO USE LIKENESS

For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the
undersigned below (You) hereby expressly agree as follows:
You hereby consent to the recording, use and reuse by Prufrock Media, Inc. (Producer), its licensees,
designees, and assigns and each of their respective parents, subsidiary entities, and affiliates, and the
respective directors, officers, employees, agents, contractors, partners, shareholders, representatives and
attorneys of each of the foregoing (collectively, Released Parties) in any and all media, whether now known
or hereafter devised, worldwide, in perpetuity, of your voice, actions, likeness (actual or simulated), name,
sobriquet, picture, photograph, silhouette, appearance, and other reproductions of your physical likeness (as
the same may appear in any still camera photograph and/or motion picture film or tape) and biographical
information (collectively Likeness) in and in connection with the production, exhibition and exploitation
of the of the television program currently entitled, "dabsity" (the "Program"), and any derivative works
thereof without any demand by you for compensation. You agree that Producer may use all or any part of your
Likeness, and may alter or modify it, regardless of whether or not You are recognizable. You further agree
that Producer and the network exhibiting the Program may use your Likeness in connection with any marketing,
promotion, publicity, advertisement, and/or merchandising for the Program and any derivative works thereof.
You understand that Producer is recording your Likeness in reliance on this consent. You acknowledge that
Producer has no obligation to use your Likeness.
You and your representatives, heirs, successors and assigns hereby absolutely, unconditionally and
forever release and discharge and covenant not to sue Producer and/or the Released Parties, from any and
all claims, demands, controversies, causes of action, damages, liabilities, costs (including reasonable
attorneys fees) and obligations whatsoever (including, without limitation, any defamation and/or false
light claim and/or claim that such use invades any right of privacy and/or publicity and/or places you in
a false light) (collectively, Claims), whether known or unknown, arising directly or indirectly out of
or in connection with the Program or any derivative works thereof and/or the recording and/or use of your
Likeness.
You agree that your remedies for any breach of this agreement by Producer or others will be limited to
damages and in no event will you be entitled to rescind this agreement or to seek any injunctive or other
equitable relief. This agreement shall be interpreted under the internal, substantive law of the State of
California without regard to the conflicts of law provisions thereof. In the event any claim or
controversy arising hereunder is not otherwise resolved through direct discussions or mediation, the
parties agree that it shall then be resolved by final and binding arbitration administered by JAMS in
accordance with its streamlined arbitration rules and procedures.
To the extent the arbitration
provisions of this agreement are not enforced or court proceedings are otherwise required, commenced or
maintained, the exclusive forum for any such disputes shall be the state and/or federal courts located in
Los Angeles County, California. You agree that the invalidity or unenforceability of any part of this
agreement shall in no way affect the validity or enforceability of any of the remainder of this agreement.
This agreement constitutes the entire agreement and understanding between You and Producer concerning the
subject matter hereof, and supersedes and replaces all prior negotiations, proposed agreements and
agreements, written and oral, relating thereto and may not be modified without the express written consent
of both parties. Producer may license, assign or otherwise transfer this agreement, in whole or in part,
to any third party. This agreement is personal to You and may not be assigned by You and any assignment
by You shall be null and void ab initio.

Please indicate your agreement to the foregoing by signing in the space provided below.
Name:
Address:
Phone:
Email:
Signature:

Date:

PO BOX 1221 Colton, CA 92324 310-403-9498 (O) 310-496-2556 (F) www.prufrockmedia.com