DISCHARGE DOCUMENT


Video recordingsfrom the day...... / ...... / ...... to...... / ...... / ........ relating to the Video
production titled:

…………………………….…………....................................................................

Following theagreement,
I
hereby………………………………………………….…….........................................
......
Born in ……………………………. And resident at …………………….......……...
street ……………………………………………..…………....................................
phone………………..……………....

AUTHORIZE
The author ofthe Video………………………..……................... (name and surname)
touse thevideo recording of my imageandmy speech, even ifnecessary
byreductionsoradjustments;

I authorizethe publication, distribution andbroadcastonpublic and private television,
internetand in cinemasandin every otherpossible andnew media with film, tape,
anddigital mediaand not, present andfuture.

IN NOEVENTI cantake it out on the author to claim damagesfor moraland material
damage causedby third partiesor derived fromuses notprovided in the
followingDisclaimer.

                    city …………...…………………… day ………/………/…….…



Signature………………………………………………….

Discharge document 7Questions

  • 1.
    DISCHARGE DOCUMENT Video recordingsfromthe day...... / ...... / ...... to...... / ...... / ........ relating to the Video production titled: …………………………….………….................................................................... Following theagreement, I hereby………………………………………………….……......................................... ...... Born in ……………………………. And resident at …………………….......……... street ……………………………………………..………….................................... phone………………..…………….... AUTHORIZE The author ofthe Video………………………..……................... (name and surname) touse thevideo recording of my imageandmy speech, even ifnecessary byreductionsoradjustments; I authorizethe publication, distribution andbroadcastonpublic and private television, internetand in cinemasandin every otherpossible andnew media with film, tape, anddigital mediaand not, present andfuture. IN NOEVENTI cantake it out on the author to claim damagesfor moraland material damage causedby third partiesor derived fromuses notprovided in the followingDisclaimer. city …………...…………………… day ………/………/…….… Signature………………………………………………….