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Form requested by :

Release provided by:

**Use of song or music by the Team Producer and/or Rāngai, is strictly limited to the film/video referenced herein

Parent/guardian if under 18)

I hereby acknowledge that I am participating in a motion picture being produced by Rāngai.

Shoot Release: I hereby irrevocably grant to the Rāngai Producer, and Rāngai, its licensees,
agents, successors and assigns, the right, but not the obligation, in perpetuity throughout the
world and in all media, now or hereafter known, to use (in any manner it deems appropriate, and
without limitation) in and in connection with the motion picture, by whatever means exhibited,
advertised or exploited:

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