Release Form

1. I hereby grant to Domino Productions LLC (the “Company”) and those acting pursuant to its authority, permission to publish and/or distribute interviews, video, photographs and my name, likeness, and biographical material (the “Materials”) in any manner and media throughout the world in perpetuity.

2. I hereby authorize the Company to:

Use the Materials as it deems appropriate in connection with any press, media release news article, collateral material, video or video testimonial.

Publish and distribute the Materials through print, video, multi-media, internet, social media, or any other advertising, marketing, and promotional media in whole or in part without restrictions or limitations for any purpose which Company and those acting pursuant to its authority, deem appropriate; and

4. I agree that video, audio, and photographs of my participation in the Project may be edited in your sole discretion. I consent to use of my name, likeness, voice and biographical material about me in connection with publicity and promotion for the Project or the Company.

5. I expressly release you, your agents, employees, licensees and assigns from and against any and all claims which I have or may have for invasion of privacy, defamation or any other cause of action arising out of production, distribution, broadcast or exhibition of such video, audio, and photographic material.

6. I warrant that I am at least eighteen (18) years of age (or, if not, that my parent or legal guardian has agreed to the foregoing and signed the attached Consent Form) and that I have the full, complete and unrestricted right and authority to enter into this release. I acknowledge that Company will rely on this permission at substantial cost to Company and hereby agree not to assert any claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder.

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