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GATO.0000.T2450 .

For good and valuable consideration, the receipt and sufficiency of which I acknowledge, in connection my potential participation in the above-referenced production (“Production”), I hereby agree as follows: I hereby authorize TBWA\Worldwide, Inc. dba TBWA\Chiat\Day, its client identified above, and their respective parents, affiliates, subsidiaries, agents, designees, licensees, successors and assigns (collectively, “Company”) to make use of my appearance in the Production identified above and otherwise in connection with Company, Company’s products and services, or for any other purpose. I agree that Company may film, tape and/or photograph me, and record my voice, conversation and sounds during and in connection with my appearance and that Company shall be the exclusive owner of the results and proceeds of such taping, photography and recording including all copyrights (collectively, the “Materials”). I agree that Company has the right to use and to license others to use, all or any portion of the Materials or any reproduction thereof in connection with the Production or otherwise throughout the world, an unlimited number of times on the Internet and in public relations materials in perpetuity. I further agree that Company may use and license others to use my name, voice, likeness and any biographical material concerning me which I may provide, an unlimited number of times in perpetuity. In agree that I will not be entitled to any compensation for the rights granted herein or otherwise in connection with this release. I represent that I have the right to enter into this agreement and that neither my appearance nor any use thereof will violate or infringe upon the rights of any third party. I hereby waive any right of inspection or approval of my appearance or the uses to which such appearance may be put. I acknowledge that Company will rely on this permission potentially, at substantial cost to Company and hereby agree not to assert any claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder, including, but not limited to, any claim of copyright infringement, libel, slander, defamation, invasion of privacy or right of publicity or any other right. I acknowledge that my potential participation in the Production will bring me into close contact with many confidential affairs of Company relating to the Production not readily available to the public, and disclosure thereof will be damaging to Company, and adversely affect the participation for others, and/or destroy the surprise, tension and outcome of the Production for the viewing public, and as such, I agree to keep and retain in the strictest confidence all confidential matters of Company and the Production, including without limitation, the identity of the potential participants in the Production and any information not publicly known that would detract from the Production’s content if it were disclosed. I understand that if I am selected to participate in the Production, my participation is contingent on my executing Company’s standard Participant Agreement in connection with the Production. This consent and release will in all respects be governed by and interpreted, construed and enforced in accordance with the laws of New York. This consent and release represents the entire understanding of the parties and may not be amended unless mutually agreed to by both parties in writing. I represent and warrant that I am at least 18 years old and have the right to enter into this release. (Please Print) Name: Address:




Phone #

(IF SIGNATORY IS UNDER 18, THE PARENT OR LEGAL GUARDIAN SHOULD DELETE THE LAST SENTENCE ABOVE AND SIGN BELOW. BE SURE TO INCLUDE ADDRESS ABOVE) I as parent/legal guardian of ______________________________ agree to the above and personally join in the warranties and representations set forth above. I sign this document to signify my agreement and agree to identify and hold harmless the Company with respect to any claims which the minor may make as a result of exercises by the Company. Parent/Legal Guardian Signature


Gatorade Release Form  

Gatorade Release Form