Simple Actor Release Form
ACTOR RELEASE
I (the undersigned) do hereby confirm the consent heretofore given you with respect to your
photographing me in connection with your motion picture/video:
Title
Production Number _________________________________________________________
and I hereby grant to you, your successors, assigns and licensees the perpetual right to use, as you
may desire, all video, still and motion pictures and sound track recordings and records which you
may make of me or of my voice, and the right to use my name or likeness in or in connection with
the exhibition, advertising, exploitation or any other use of such motion picture or recording.
I also understand that it takes a significant amount of time to complete a film – and in some cases
student films are abandoned and not completed at all. If the student filmmaker has promised a tape
of the film I agree to allow a reasonable amount of time to elapse after the performance for
completion (i.e. six months).
I am over eighteen years of age
I am a member of the Screen Actor’s Guild
Signature
Name (print) ____________________________________________________________
Address
Phone Number ___________________________________________________________
Character Name __________________________________________________________
PM/AD/ Student Filmmaker _____________________________ Phone
SFTV Class _________________________________________ Date _______________
8/05
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