Release Form

Production company name:

Location of company:

I give                                                                    its successors and assignees, my unrestricted permission to make, distribute and /or sell, still photographs, video recordings and/or sound recordings taken of me for the programme entitled :

the nature of which has been fully explained to me.

I understand my contribution will not be mis-represented or taken out of context. I understand the distribution of the production will be for educational assessment purposes.

Signed:

Print name:

Address:

Date:

Signature on behalf of Company:

Print name:

Date: