Video Release Form

I do hereby grant and give to TRIAD,INC., its successors and assignees, the right to use, and to permit others to use, my photograph, voice or image on a film, videotape or other sound and/or visual recording device, with or without my name, both singly and in conjunction with other persons or objects, for any and all purposes including, but not limited to, private or public presentations on radio, television, in theatres, or in other public or private places, and advertising, publicity and promotion relating thereto.
I warrant that I have the right to authorize the foregoing uses, and do hereby agree to hold TRIAD, INC. harmless of and from any and all liability of whatever nature which may arise out of or result from such uses.

Name(Required)

First Last

Signature(Required)

Date(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

(TO BE COMPLETED BY PARENT OR LEGAL GUARDIAN IF RELEASOR IS UNDER 18)
I, being the parent or legal guardian of the above named minor, for the consideration stated above, do hereby consent to and approve of the foregoing release, and I further agree that in the event the said minor repudiates or attempts to repudiate such release, I will personally indemnify and harmless TRIAD, INC. its successors and assignees, from any and all loss and damage occasioned thereby.

Name

First Last

Signature

Date

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