Personal Release Form

I give Petra Daher, Petra Productions, Daher Digital Video, and their successors and assigns my unrestricted permission to use my artwork, voice, music, and or image for either still photographs, film, video or live productions.

Signature:___________________________________________

Name (please print)__________________________________

Address:_____________________________________________

City:___________________State:______________Zip_______

Email:_______________________________________________

Date and year:________________________________________

Signature of guardian if under18:


Witnessed by:________________________________________

Date:_________________________________________________

Copyright Petra Daher, Petra Productions/Petra Daher Productions 2010