STEELTOWN ENTERTAINMENT PROJECT YOUTH & MEDIA

“TAKE A SHOT: TEEN FILM PRIZE” CONTEST

TALENT RELEASE FORM

Name of contestant(s): _______________________________________________________________________________________________________________________________________________________________________________________________________________________

School or Community-based Organization:

_________________________________________________________________________________________________________________________

Name of sponsor (Parent/Guardian, Teacher, Educator): ________________________________________________________

Date of filming: ____________________________        

Length of film: ______________________________

Name of film: ____________________________________________________________________________

I, the undersigned, hereby assign all rights and release from liability the above-mentioned contestant(s) and Steeltown Entertainment Project (“Steeltown Entertainment”) for the recording, editing, exhibition, sale, and distribution of my visual image, voice and performance as embodied in footage and images used in creating the video entries for the “Take a Shot: Teen Film Prize” contest.

I agree that Steeltown Entertainment has the right to use and distribute the above-mentioned footage and video including, but not limited to, television, online, educational and commercial use and distribution. I waive any right to compensation and agree that these rights shall extend throughout the world and in perpetuity.

TALENT (Person who appears on camera). Signatures are required from each person.

PARENT/GUARDIAN PERMISSION REQUIRED IF TALENT IS YOUNGER THAN 18 YEARS OF AGE

Printed name: ______________________________________

City: ____________________State: _________ Zip:_______

Signature: _________________________________________

Date: _______________________

Parent/ Guardian Printed name: ______________________________________

City: ____________________State: _________ Zip:_______

Signature: _________________________________________

Date: _______________________

If you have any questions or requests for further information, please contact:

Jen Taormina-Lawson, Production Manager 412-251-0890 or jen@steeltown.org

Forms can be mailed to:

Steeltown Entertainment Project

2100 Wharton St, Ste. 708

Pittsburgh, PA 15203

Or faxed to: 412-251-0893