Romano Film & Photography, Inc. aka Romano Productions  1622 Wenonah Trail Mohegan Lake, New York 10547 Tel: (845) 528-3845 Fax: (845) 528-3846 Standard Consent and Release Form I hereby CONSENT that Romano Film & Photography, Inc. (aka Romano Productions) and its agents may record my likeness and/or voice by any means including without limitation films, tapes and photographs. I also CONSENT that Romano   Film   &   Photography,   Inc.   or its designees, or licensees, may reproduce, exhibit and otherwise exploit such recordings, with or without the use of my name, in whole or in part throughout the world in perpetuity. I understand and agree that the recordings of me may be used in any manner or media and for any purpose including without limitation, television broadcast, advertising, promotion, trade and editorial purposes in connection with Romano Film & Photography, Inc.   and/or the Program. Romano Film & Photography, Inc. shall own all rights in the recordings made here under and may obtain, in its own name or otherwise, copyright for or including material containing my likeness, voice and/or name as a part of any permanent record which Romano Film & Photography, Inc.  shall make of the recordings. However, nothing shall require Romano Film & Photography, Inc.  to include me in any material or to broadcast or otherwise exploit same. I hereby RELEASE Romano Film & Photography, Inc. and its designees licensees from liability and any claim for violation of any personal proprietary right I may have in connection with the recordings of me and their use by Romano  Film   &   Photography,   Inc.   and its designees or licensee. I forever RELEASE, discharge and agree to hold harmless Romano   Film   & Photography,   Inc.   its representatives, assigns and all persons acting under its permission or authority, from and against any and all claims, liabilities, costs, damages and obligations arising from the use of my likeness, voice and/or names as set forth herein. I hereby warrant that I have fully agreed and have every right to execute this CONSENT AND RELEASE prior to executing it and I am familiar with its contents. If this CONSENT AND RELEASE is executed by a parent or guardian, I further warrant that I have the power and right to so execute this CONSENT AND RELEASE on behalf of the minor person named below. Date:___________________________________________________________________ Signature:_______________________________________________________________ Name (Print):____________________________________________________________ Parent’s/Guardian Signature:______________________________________________ Parent’s/Guardian Name:__________________________________________________ Telephone:______________________________________________________________ Address:________________________________________________________________