Release Form for Media Recording

I, the undersigned, do hereby consent and agree that the People First of Nevada, its employees, or agents have the right to take photographs, videotape, or digital recordings of me beginning on _______ and ending on _______ and to use these in any and all media, now or hereafter known, and exclusively for the purpose of ________________________. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to People First of Nevada, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

I also understand that People First of Nevada is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

Name: ___________________________________ Date: _________

Signature: ________________________________

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