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ON CAMERA RELEASE 

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ON CAMERA RELEASE 
ON CAMERA RELEASE AUTHORIZATION TO REPRODUCE PHYSICAL LIKENESS, VOICE, AND OTHER SOUNDS
For good and valuable consideration, the receipt of which from Palm Beach State College
is acknowledged, I hereby grant to said Palm Beach State College and its employees, agents and
assigns, the right to photograph me and use my picture, silhouette, and other reproductions of my
physical likeness (as the same may appear in any still camera photograph and/or motion picture
film or videotape recording), in and in connection with the exhibition, theatrically, on television or
otherwise, or manufacture of videocassettes, of any motion pictures or videotape recordings in
which the same may be used or incorporated, and also in the advertising, exploiting and/or
publicizing of any such motion pictures, but not limited to television or theatrical motion pictures. I
further give Palm Beach State College the right to reproduce in any manner whatsoever any
recordings made by Palm Beach State College of my voice and all instrumental, musical or other
sounds produced by me.
I hereby certify and represent that I have read the foregoing and fully understand the meaning and
effect thereof and, intending to be legally bound, I have hereunto set my hand this
____________________ day of ____________ ________.
___________________________________
Print Name
____________________________________
Telephone #
___________________________________
Street Address
____________________________________
Signature
___________________________________
City
State
Zip
____________________________________
Witness
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