I hereby consent and agree that Blaze Productions and any of its employees or agents have the right

to take photographs, videos and digital recordings of me in any setting and in any costumes that they choose for me from the _________________ However this permissions end on the ___________________ I give my full permission for any and or editing that they require for their media now or hereafter, though exclusively for the purpose of the film magazine, poster and teaser trailer. I further consent that my name and identity may be revealed and or changed depending on the companies need. I release Blaze Production its agents and employees all rights to exhibit this work in full print and digital form, publically and privately and to market, advertise and sell copies. I fully understand that there will be no financial compensation for my services in anyway shape or form.

I have read and fully understood the foregoing statement and I consent to the execution of this agreement. Name:___________________ Date:________________

Witness for the sign:____________________

Signature of Model:________________