Glass Box Film Waiver Form

Glass Box Film Waiver Form
We would like to invite you to take part as an extra in our film, Glass Box. We will be filming a scene with Summer Hanson as the main character and would love to have you, her community, as part of the film!
The film will be submitted to film festivals and possibly submitted to platorms such as Vimeo for our community to view and enjoy!
- I grant permission for Sterling Bird to record and use footage of me in the manner and for the purposes stated above.
- I agree that Sterling Bird will own the copyright and other intellectual property rights in any material produced.
- I waive the right to inspect or approve the finished interview/film prior to publication.
- I agree that footage, still images or excerpts may also be used for general promotional purposes by Sterling Bird and partners in the future without notifying me.
To accept and confirm your agreement to this permission form, please sign and date below.
Name

First NameLast Name
Email (optional)
example@example.com
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Signature
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty: