In order to legally broadcast the video online & on TV, we need a signed talent release form for each participant.

EASIEST WAY TO SUBMIT: Sign a copy we will have for you at Maple Street School on taping day.

OR: Download this form, print it, sign it, & bring it with you on taping day.

OR: Download this form, print it, sign it, & mail to Saragail Benjamin, PO Box 486, Manchester Center, VT 05255.

IF YOU ARE UNDER AGE 18—A PARENT/GUARDIAN NEEDS TO SIGN THIS FORM for you to participate in the video.  

I hereby assign Saragail Benjamin, producer, all rights worldwide and in perpetuity to the recording and/or taping of my voice by means of audio recording software and audio record, and my appearance by means of videotape, SD card capture, and still photography made on June 1, 2014. I hereby further authorize the reproduction, copyright, sales, exhibition, cablecast, webcast and/or distribution of said videotape/program/SD card capture/still photography/audio record by Saragail Benjamin without limitation. I understand that permission allows Saragail Benjamin to distribute the production and/or excerpts of the production and/or excerpts from the production, and I understand distribution may include video contests, internet, public and commercial television stations, print publicity and any distributions available to this producer. I further agree to release, discharge and indemnify Saragail Benjamin from any legal proceedings which may arise in relation to the conditions stated above.

Print Name (Talent): _______________________________________

Signature (Talent): ________________________________________

Date: _________________________________________________

The talent is under age eighteen. The person named above being a minor has my consent as parent/guardian to be a video/audio program talent outlined above

Print Parent/Guardian Name:________________________________

Parent/Guardian Signature: ___________________________________

Date: __________________________________________________

Thanks so much for your cooperation!


 You may download this form as a PDF

Website Maintenance & Support by Bytes.co