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1. HAYDON MEDIA
ACTOR RELEASE FORM
I (the undersigned) hereby grant to Jack Bowyer 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 Moving To New York.
Production Synopsis
A performance music video for the song Moving To New York by The Wombats.
Actor Role
The actor is music video performed the song by singing the lyrics as well playing some
of the instruments; guitar and drums(for one scene only).
Consent
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: Ben
Signature: ________________________________________ Date: 19/01/2018
Email: BenDiamond247@gmail.com
PRODUCER NAME: Jack Bowyer
PRODUCER EMAIL: JackBowyer123@gmail.com