Actor Model Release Form

I hereby grant and authorize Premium Healthcare and its affiliates associated with Premium Healthcare the right to take, edit, alter, copy, exhibit, publish, distribute, and make use of any and all video taken of me to be used in and/or for any lawful purpose. 

This authorization extends to all languages, media, formats, and markets now known or later discovered.

This authorization shall continue indefinitely.

I waive the right to inspect or approve any finished product in which my likeness appears.

I agree that there will be no monetary compensation of compensation of any kind in exchange for use of my likeness or have otherwise. I have agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the video. 

I understand and agree that these materials shall become the property of Premium Healthcare  and will not be returned.

I hereby hold harmless and release Premium Healthcare from all liability, petitions, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

My signature on this webpage confirms the statements above to be true.