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TALENT RELEASE FORM

PARTICIPANT'S NAME:
_____________________________________________________
PROJECT: “Footage Capture for NYC Covid-19 Photo/Video Library”

For good and valuable consideration, the receipt andlegal sufficiency of which is hereby
acknowledged, I____________________________________ (“Model”) hereby grant to
Hsubox Productions Inc. (collectively, the “Photographer”),the Photographer’s assigns,
and those persons acting with the Photographer’s authority and permission, the right to
take and create photographs/videos and other still and/or moving images (in all formats)
and other graphical depictions incorporating my likeness, in any and all media, whether
now known or hereafter created (the “Content”).

I hereby agree that all rights in and to the Content, including the copyright, are and shall
remain the sole property of the Photographer, free and clear from any claims by me or
anyone acting on my behalf.

The Photographer’s rights include, but are not limited to, the rights, in perpetuity, to:

Use, re-use, publish, and re-publish the Content; Alter, modify or otherwise change the
Content in any manner the Photographer desires; Combine the Content with textual
matter and/or with other pictures and/or media; and, Use the Content for illustration,
promotion, art, editorial, advertising, trade, publishing, or any other purpose whatsoever.

I hereby release, discharge, and agree to hold harmless the Photographer, legal
representatives and assigns, and all persons acting under the Photographer’s authority or
those for whom he/she is acting, from any liability by virtue of any use of the Content or
any changes or alterations made thereto.

I hereby warrant that I am of full legal age and have the right to contract in my own
name. I have read the above authorization, release and agreement, prior to its execution,
and I am fully familiar with the contents thereof. This release shall be binding upon me
and my heirs, legal representatives and assigns.

I confirm that any and all material furnished by me for this program is either my
own or otherwise authorized for such use without obligation to me or any third party. I
also agree to the use of my voice and likeness in video form, portrait or pictures, and any
audio use for educational, program or series publicity and organizational promotional
purposes.
I further agree that my participation in the program confers upon me no rights to use,
ownership or copyright in perpetuity and throughout the universe of the Project
It is understood that Photographer is under no obligation to broadcast or use the above-
identified program(s) or series.
As compensation I will receive $100.00 by electronic delivery and review of footage
upon written
Model Information:

Name (Print): ________________________________________________

Address: ___________________________________________________

City: __________________________ State: ________________________

Country: _________________________ Zip/Postal Code: ____________

Phone: __________________

Email: ______________________________

Date of Birth: ____________(for age verification reasons)

Model Signature: ____________________________________________________

Parental/Guardian Signature (if participant is under 18 years old):


____________________________________________________

Date: ________________________________________________________

Description of Scene: ____Clapping on Balcony for 7pm Essential workers _______


__________________________________________________________

Venmo/Paypal/Quickpay/Zelle/wire transfer information for payment:


________________________________

Photographer information:

Hsubox Productions Inc.

1582 John Street, Fort Lee, NJ 07024, USA

[email protected]

646-820-2789

Date of Shoot: 4/8/2020

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