RELEASE

I have agreed to participate in the production of a television program (the “Program”) being produced by Henry J. Productions (“Producer”).  As consideration for the possibility of appearing in the Program, I hereby acknowledge and agree as follows:

1.  NAME AND LIKENESS.   I hereby consent to the recording and use of my name, likeness, image and voice (collectively “Likeness”) and all performances, stories, songs, artwork, statements, or actions made by me, or information given by me, whether written, spoken, sung, or otherwise expressed by me (collectively “my Performance”), worldwide, in all mediums, by Producer and any television network or station broadcasting or otherwise distributing the Program, and each of their respective assigns, successors, parent, affiliated and subsidiary companies and their respective licensees and advertisers (collectively “Producer and Distribution Entities”), in and in connection with the Program and the production, broadcast, distribution, exhibition, advertising, marketing and promotion of the Program and merchandising related to the Program, and in advertising and promotion for any of the Producer and Distribution Entities.  I affirm that I am the sole copyright owner of the musical composition or any and all parts of my Performance and/or have performance rights for my Performance on the Program.  This agreement allows the broadcast of this Program, while eliminating any external licensing requirements of RIAA, Soundexchange, BMI, SESAC, ASCAP, or any other performance rights organizations.  The Program or any part thereof (including without limitation my Likeness and/or Performance) can be edited, cut, added to, adapted, dubbed, modified and/or rearranged at Producer’s sole and absolute discretion.  Without limiting the foregoing, I acknowledge that Producer may juxtapose any part of the recordings of me with any other part of the recordings of me in the Program, and alter the sequence of events or of any questions posed and/or answers given in recordings of me in and in connection with the Program.  My contribution to the Program is specially ordered by Producer as part of an audiovisual work as a work made for hire for Producer.

2.  RELEASE OF CLAIMS.  I agree that I will not assert or maintain, or consent that others assert or maintain, any claim or action of any kind whatsoever against Producer, parent or subsidiary entities, successors, licensees, assigns, officers, directors, agents, employees and/or shareholders of each, on the ground that (i) anything contained in the Program or in the advertising or publicity issued in connection therewith or (ii) the use by Producer or its successors, licensees or assigns of recordings made by me in connection with the Program violates any of my rights or portrays me in a defamatory, false and/or negative light.

3.  MISCELLANEOUS.  I agree that the invalidity or unenforceability of any part of this release shall in no way affect the validity or enforceability of any of the remainder of this release.  This release constitutes the entire agreement and understanding between me and Producer concerning the subject matter hereof, and supersedes and replaces all prior negotiations, proposed agreements and agreements, written and oral, relating thereto.  This release and the rights hereunder may be freely assigned by Producer.  Producer is not obligated to use my Likeness or Performance in any way or include my Likeness or Performance in the Program.  My appearance in and in connection with the Program is as a non-performer only, and is not employment, and does not entitle me to wages, salary or other compensation.  In no event shall I be entitled to enjoin or otherwise interfere with the production, distribution or exhibition of the Program.  

__________________________________________          ____________________         ______________

Signature                                                                               Date                                         Date of birth 

____________________________________________     _______________________________________

Name (Please Print)                                                             Address (Street)

Phone: (_______)_________________          __________________________________________________

                                                                           (City)                                            (State)                   (Zip)

Parental Consent (if signatory is a minor):  I represent and warrant that I am the parent or legal guardian of the minor whose name appears above, and that no additional release is required, that I have read and approve of the foregoing release, and consent to its execution by my child/ward.  I hereby fully and unconditionally guarantee the performance of my child’s/ward’s obligations and the grant of rights as set forth above.

Signature of parent or guardian                                  Printed Name                                Date

Address                                                    City                                            State                  Zip              Phone number