Video Release Form

Comedian or Recording Artist
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Full Name:
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Stage Name:
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Song Name: (Recording Artist only)
Are you the song copyright holder?:

Yes
Email Address:
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I, hereby authorize DH ONE NETWORK, and its partners, agents, representatives, assigns, successors in interest and licensees, to photograph, audiotape, and/or videotape me and grant DH ONE NETWORK and its partners the irrevocable right to use my photograph, audio recording, video recording, or any reproduction or modification thereof (the “Photograph,” “Audio,” and/or “Video”), in any manner or medium throughout the world an unlimited number of times in perpetuity in advertising, commercial use, promotion & exhibition, or any other lawful purpose. I understand that I will not receive any monetary compensation for the permissions I am granting herein. I hereby waive any right of inspection of approval of the uses to which DH ONE NETWORK, may put the Photograph, Audio, and/or Video. I acknowledge that DH ONE NETWORK will rely on this permission and hereby release and discharge (DH ONE NETWORK), from any and all claims and demands arising out of or in connection with the Photograph or the exercise of the permissions granted here, including any or all claims for libel, invasion of privacy, or emotional distress. I understand that I cannot withdraw my consent after I sign this form and that this consent and release is binding on me and my heirs, legal representatives and assigns. Please check "Yes" for the following: I grant permission for Photographs to be collected and used by DH ONE NETWORK. I grant permission for Audio to be collected and used by DH ONE NETWORK. I grant permission for Video to be collected and used by DH ONE NETWORK.
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Yes
Date
Time
Electronic Signature:
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