Release Form

My Name Is Raj

Your Name (required)

Your Email (required)

I hereby consent and agree to the terms and conditions below as the Parent/Guardian of:

Child’s Name

Image ID Number:

Location: Montreal, Canada

I hereby voluntarily authorize Srinivas Krishna and Divani Films Inc. (“Producers”) with offices at 675 King St West Suite 211 Toronto ON M5V 1M9 Canada (, their authorized representatives and/or any third party they may authorize, to photograph and record my (or my child’s) appearance and performance on film, tape, digital media or otherwise (my “Image”) and hereby grant to Producers on an exclusive basis and without reservation all right, title and interest of every kind and character whatsoever, including copyright, in perpetuity in and to said Image and the results and proceeds thereof. The rights granted hereunder include, without limitation, the right to reproduce my Image (“Reproduction”); to edit same at Producers’ sole discretion (“Alteration”); to include same with the Images of others and with recorded dialogue and narration, sound effects, special effects and music (“Recordings”); to use my Image and its Reproductions, Alterations and Recordings in the production, distribution, and exhibition of the art installation entitled My Name Is Raj and any and all versions and iterations thereof (“Work”) in any manner of media whatsoever throughout the world in perpetuity; to use and to license others to use my Image and its Reproductions, Alterations and Recordings, as well as my name and any biographical information provided by me, in any manner of media whatsoever throughout the world in perpetuity, for publicity, advertising and sales promotion of the Work; and, the right to assign or otherwise dispose of all of the rights granted hereunder without payment to or consultation by me.

In addition, I agree to the following:

  • I have been given adequate notice of the above terms and conditions and have had a meaningful opportunity to review them;
  • By choosing to enter my details and clicking “I Accept” below, I give my full consent to the terms and conditions of this Agreement;
  • I am entering into this Agreement voluntarily.