Extras Release Form

RELEASE FORM FOR NON-UNION EXTRA/BACKGROUND ACTOR

I am a non-union actor, agreeing to appearing in {name of production}, produced by {production company}.

I ___am ___am not receiving any compensation for my participation in this project. If I am being compensated, the compensation is as follows: {amount per day, flat rate, etc.}.

I agree that this compensation, if any, is the only compensation I will receive for my participation in this project.

I hereby grant {production company} the right to record and use my image, voice, likeness, performance, etc. for the purposes of this production.

I further grant {production company} to use and/or distribute any material filmed, taped, recorded of me in the production, as well as any promotions or advertising related to the production.

Signed:

_________________________
Name

_________________________
Signature

_________________________
Date

_________________________
Address

_________________________
Address

_________________________
Phone