Name of Film ______________________________________________________
Name of Production Company/Organiser __________________________________________________________________ __________________________________________________________________ Date of Filming _____________________________________________________ Name of Contributor_________________________________________________
In consideration of the organiser agreeing that I contribute to and/or participate
in the film, the nature and the content of which has been fully explained to me. I consent to the filming and recording of my contribution to and/or participation in the film subject to the terms and conditions specified below.
Signed by contributor________________________________________________ Date ______________________________________________________________
If the contributor is 18 or under this form must be signed by a parent or Legal
guardian. I consent to [name of contributor] entering into this agreement.
Signed by Parent or Guardian_________________________________________