I the undersigned, do hereby irrevocably grant to Santa Cruz Revival & Revive TV, it's officers, partners, agents, and employees, the absolute right and permission to record my likeness and/or voice with still photography, film or videotape, to edit such photographs, film, or videotape at SCR and Revive TV's discretion, to use or authorize the use of still photographs, films, and/or videotapes, or any portion thereof, in any manner at any times. I hereby release, discharge, and agree to hold harmless SCR and Revive TV from any and all claims, damages, liabilities, costs, and expenses that I now have or may hereafter have by reason of any use of the film, videotapes, and/or photographs thereof.  I further expressly agree that the foregoing release is intended to be as broad and inclusive as is permitted by the law of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I have read this release, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the release freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

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Name: Signature:

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Date:

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Name of Parent/Guardian: Signature:

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(Optional):Email & physical address & phone:

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