Page 1 of 1

Video Release Form

I authorize the undersigned Producer to make use of my appearance on:

Program Title: Henry’s Listening Room
Producer's Name: Henry Turner Jr.
Producer's Phone Number: 225-802-9681

I understand that I am to receive no compensation for this music video being used in the aforementioned program. I further acknowledge that I have the right to grant the producer the right to utilize it in the production as the artist. In addition the producer shall have complete ownership of the program. I give the Producer the right to use my video, name, likeness and biographical material to publicize the program and the services of the Producer.

The Producer may:

1. Use the video production, my voice and likeness for the purposes of the production mentioned above, whether by film, videotape, magnetic tape, digitally or otherwise: 2. Make copies of the images and recording so made: 3. Use my name and likeness for the purposes of education, promotion or advertising of the sale or trading in the photographs, recordings and any so made: 4. License: Licensor hereby grants to Licensee the exclusive worldwide rights to exploit the Content as described herein on Streaming, FAST, OTT, TVOD, SVOD, AVOD, SVOD, PEST, MVPD, and the non-exclusive, worldwide rights to exploit the Content on Linear Broadcasting platforms, including but not limited to Licensee’s Soul of the South (SNN) Diginet. I further understand the master tape remains the property of the Producer and that there will be no restrictions on the number of time that my name and likeness may be used.

Acknowledgement of terms

I acknowledge I have read and agree to the terms above.

Your Name

Your Email

Today's Date

Address Line 1

Address Line 2

City

State

Zip Code

Talent Signature (Parent or Guardian if under 18)

Signature

Stage Name

Production Credits

Video Title/Name of Song

Director

Producer

Artist

Publishing Company

Music Rights Affiliation

Additional Info

Video Link/File Download

Insertion Fee and Legal Acknowldegment

Please pay our $75 video insertion fee with either PayPal or Cash App.

Insertion Fee and Legal Acknowldegment

I acknowledge that if my video is selected, I will be responsible for paying a $75 video insertion fee.

I have the rights to use all images and sounds in the video that I am submitting to "Henry’s Listening Room" TV Show and I hold harmless Henry Turner, Jr. and "Henry’s Listening Room" TV Show from all claims or liability concerning the video. I am submitting to be aired on the television show.