This actor release form grants Eleanor West permission to photograph and record Bethany Barrows for the student film "Hurt Together". Bethany agrees to adhere to the agreed upon schedule and make herself available for potential reshoots. By signing, Bethany certifies that she understands the meaning and effect of the release form.

1. HAYDON MEDIA
ACTOR RELEASE FORM
I (the undersigned) hereby grant to ___Eleanor West__ the right to photograph me and to
record my voice, performances, poses, actions, plays and appearances, and use my picture,
photograph, silhouette and other reproductions of my physical likeness in connection with the
student motion picture tentatively entitled __Hurt Together_________.
By my signature here I understand that I will, to the best of my ability, adhere to the schedule
agreed to prior to the beginning of my engagement. Additionally, I agree, to the best of my
ability, to make myself available should it be necessary to undertake re-shoots.
I hereby certify and represent that I have read the foregoing and fully understand the meaning
and effect thereof.
Name: _ Bethany Barrows_________
Signature: ________________________________________ Date: 10/10/17_____
Telephone:__07452963212___ Email: __missblbarrs@gmail.com_______
PRODUCER NAME: __Eleanor West__________________
PRODUCER TELEPHONE: ___07781536017________________________
PRODUCER EMAIL: ___eleanorw@yahoo.com_______________________