I, hereby agree that [INSERT NAME] (“Authorized Person”) and Pixellot, Ltd./ Pixellot Inc. (“Pixellot”, together with Authorized Person, the “Authorized Parties”) are authorized to record me, and to use in such recordings my name, image, likeness, actions, voice and/or statements (collectively, “Likeness”), without further authorization or any compensation, worldwide, in any media, whether now known or hereafter devised, for any legal purpose (including, without limitation, commercial and promotional purposes). Authorized Person owns all right, title, and interest to any materials, recordings, and photographs incorporating my Likeness that are created hereunder, and any derivative works created therefrom (“Works”). The Authorized Parties may use, edit, adapt, modify, make derivative works of, publicly perform and publicly display, reproduce, and distribute the Works, in whole or in part, directly and through sublicensees. I understand the Authorized Parties have no obligation to use my Likeness or any Works.

I hereby release, hold harmless, and forever discharge the Authorized Parties from any and all claims, actions, causes of action, demands, rights, damages, costs, and expenses arising out of, related to, or in any way connected with the exercise by the Authorized Parties of the rights granted herein, including, without limitation, any and all claims for invasion of privacy, infringement of my privacy, publicity, and/or intellectual property rights, defamation, or portrayal in a false light.

This release contains the entire understanding of the parties with respect to the use of my Likeness and related Works and supersedes all prior understandings and communications. The invalidity or unenforceability of any provision of this release shall not affect the validity or enforceability of the remainder of the release. This release cannot be terminated, rescinded or amended, except by a written agreement signed by the Authorized Parties and me.

By signing this release, I represent and warrant that (i) I am eighteen years old or older, or if under 18 years old on this date, my parent or legal guardian has also signed the below, (ii) I understand and agree to the terms of this release, and (iii) no payments or royalties to, or consents from, any third party are required in connection with the Authorized Parties’ use of any of the rights granted herein.




If you are under 18 years old, then your parent or legal guardian must sign below.

Parent/Guardian’s Signature:  
Parent/Guardian’s Printed Name: