Turn Up The Bass
Shuffling Competition Music Video
Instagram Username (If applicable)
Link to video
Link to 2nd take video (if applicable)
Video release form
I hereby grant Dirty Dutch Music / Chuckie the irrevocable right and permission to use video recordings of me on websites, promotional flyers, derivative works, or for any other similar purpose without compensation to me.
I understand and agree that such video recordings of me may be placed on the Internet. I also understand and agree that I may be identified by name and/or title in printed, Internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I agree that all such video and audio recordings, and any reproductions thereof, and all digital files are and shall remain the property of Dirty Dutch Music.
I hereby release, acquit and forever discharge Dirty Dutch Music / Chuckie from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.
I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name. This release is binding on me and my heirs, assigns and personal representatives.
I am over 18 years of age
Name of individual recorded
Do Not Fill This Out