This is the wording that I use ( I need coverage for video, film and photographic purposes):
I hereby accept to be filmed or photographed by __insert business number__ Canada Inc. for the production entitled ___ insert production name____.
DATE: ____________________________
NAME: _____________________________________________________________
ADDRESS: __________________________________________________________
TEL: ______________________________
I hereby release all rights pertaining to the audio and/or video recording, production and/
or reproduction of my voice, my person or other materials described above, and on all
forms of exploitation and representation for audiovisual, televisual, cinematographic,
videographic, photographic, public display, as well as all domicile representation by
all modes of transmission, without limitation by hertzien waves, by cable, by satellite,
by fiber optics, by numeric numbering or by any other medium in existence or to be
invented for the purpose of exploitation of the series in question and of all its future
versions in all languages for the entire world in perpetuity.
DESCRIPTION OF MATERIALS
I hereby declare and guarantee that the rights granted by the present and their use
under the present terms will not constitute an infringement or a violation upon a
commercial brand name, a copyright or an intellectual property right of a third party. By
the present, I hereby disengage ___insert business number___ Canada Inc. from
all responsibilities related to legal pursuits, complaints or claims that may follow the
cessation of the rights and their usage in the present terms, except in those cases where
there may be negligence on the part of __insert business number__ Canada Inc.
and to exonerate it from all blame related to all complaints and expenses and to all the
costs, expenses and damages due to a breach of guarantee given here above.
SIGNATURE: _______________________________________________________
WITNESS: __________________________________________________________