GraceTime and The GraceTime Project requires permission from all individuals in the movie produced ( minors by parents or legal guardians) for all images and videos taken. Please read the Image and Video Release Form and sign at the end giving your consent.

       1.   Irrevocable License and Release Re: Use of Motion Picture Product, Image, audio and Likeness
             I attest that I am at least eighteen years of age and hereby authorize, permit, and license GraceTime / The GraceTime Project to forever:

             a.  use, promote, license, distribute, lend, display and publish my work in any and all media, as submitted to GraceTime (or the GraceTime Project) and hereby release them from all liability and claims that may arise out of the exercise of said authorization, permission, and license
             b. use, separately or together, my name, picture, image, audio or other likenesses in any and all present and future media for the purposes of advertising, publicity and trade related to material submitted to GraceTime (or The GraceTime Project ). I understand that there will be no financial or other remuneration for the use of my name, picture, image, or other likenesses and hereby release GraceTime (or The GraceTime Project) from all liability and claims resulting from or connected with the publication of such work.

             _________________________________________      ______________________                ______________________________________________________
                 Movie Title, Subject, Name or purpose                                  date submitted                                    Location of production

            __________________________________________     ______________________               ______________________________________________________
                    Indivigual full name                                                              birth date                                            Appointment time

            ___________________________________________________________________             _______________________________________________________
                    Home  address                      city,state & zip code                                                                         E-Mail address

            _________________________________________     _______________________              _______________________________________________________
                     Applicant Signature                                                              date signed                                        Telephone number

I hereby attest that I am at least eighteen years of age, have legal custody of ________________________, and consent to and execute on said minor's behalf the foregoing Irrevocable License and Release Re: Use of Motion Picture Product, Image, audio and Likeness for the use and benefit of GraceTime (or The GraceTime Project) and do so knowingly and voluntarily.  I further release GraceTime (or The GraceTime Project) from all liability and claims that said minor has or may have that arise out of or relate to the execution and use by GraceTime (or The GraceTime Project) under said License.

          ___________________________________________________________________
                Parent or Guardian name                            please print

          _________________________________________  _________________________
                Parent or Guardian name signature                                                        date signed


You may download this document as a "rich text format (.rtf)"  at  http://www.gracetime.com/movie/gracetimeReleaseForm.html   ..
 .Fill in the blanks and send via e-mail to gracetime@yahoo.com, Atten:  GraceTime  Release Forms,  or call 913-522-8513 as requested.     copyrite 2015, GraceTime®