Thursday 13 February 2014

Contributor release form

PROGRAMME TITLE: Channel 21 News - Interviewed for train VT

Date of Recording: Friday 31st January

To: South Essex College - Southend campus, Luker Road, Southend-On-Sea, Essex SS1 1ND


I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with East Coast Media’s Representative.

I agree to and hereby give all consents and permission and grant any licence that be required under any legislation or regulation to permit my contribution/performance to be used in whole or part in any manner by East Coast Media in all media without restriction.

My contribution will be an honest and truthful account of my experience and I confirm that I have not misled East Coast Media in any way as to my identity, experience, or as to the nature and/or content of my Contribution.


Name: Julie Smith


Address:  South Essex College - Southend campus, Luker Road, Southend-On-Sea , Essex SS1 1ND


Signed: J.Smith



Date: 31/01/14



Where the contributor is under 18 years of age, I confirm that I am the parent/guardian and agree my acceptance of the above on behalf of the contributor.


Signature:   N/A


 
 
PROGRAMME TITLE: Channel 21 News
 

Date of Recording: Friday 31st January

To: South Essex College - Southend campus, Luker Road, Southend-On-Sea,  Essex SS1 1ND

I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with East Coast Media’s Representative.
I agree to and hereby give all consents and permission and grant any licence that be required under any legislation or regulation to permit my contribution/performance to be used in whole or part in any manner by East Coast Media in all media without restriction.
My contribution will be an honest and truthful account of my experience and I confirm that I have not misled East Coast Media in any way as to my identity, experience, or as to the nature and/or content of my Contribution.
 

Name: Darren Cox

Address: 2 Arundel Road, Rochford

 

Signed: Darren.C

Date: 31/01/14

Where the contributor is under 18 years of age, I confirm that I am the parent/guardian and agree my acceptance of the above on behalf of the contributor.
 

Signature: N/A



_________________________________________________________________________________
The MBG



PROGRAMME TITLE: Channel 21 News - Band member filmed for music VT


Date of Recording: Wednesday 29th January

To: South Essex College, Luker Road, Southend-On-Sea,  Essex SS1 1ND

I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with East Coast Media’s Representative.

I agree to and hereby give all consents and permission and grant any licence that be required under any legislation or regulation to permit my contribution/performance to be used in whole or part in any manner by East Coast Media in all media without restriction.

My contribution will be an honest and truthful account of my experience and I confirm that I have not misled East Coast Media in any way as to my identity, experience, or as to the nature and/or content of my Contribution.



Name: Laura Allison


Address: 105, Norsey View Drive, Billericay



Signed: L.A



Date: 29/01/14



Where the contributor is under 18 years of age, I confirm that I am the parent/guardian and agree my acceptance of the above on behalf of the contributor.


Signature: Cindy.Alison





PROGRAMME TITLE:

Channel 21 News - Band member filmed for music VT

Date of Recording: Wednesday 29th January
To: South Essex College, Luker Road, Southend-On-Sea,  Essex SS1 1ND

I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with East Coast Media’s Representative.

I agree to and hereby give all consents and permission and grant any licence that be required under any legislation or regulation to permit my contribution/performance to be used in whole or part in any manner by East Coast Media in all media without restriction.

My contribution will be an honest and truthful account of my experience and I confirm that I have not misled East Coast Media in any way as to my identity, experience, or as to the nature and/or content of my Contribution.


Name: Ben Miles

Address: 56 Walton Gardens, Hutton, Brentwood


Signed:  Ben.Miles


Date: 29/01/14


Where the contributor is under 18 years of age, I confirm that I am the parent/guardian and agree my acceptance of the above on behalf of the contributor.

Signature: D.Miles



PROGRAMME TITLE: Channel 21 News - Band member filmed for music VT


Date of Recording: Wednesday 29th January

To: South Essex College - Southend campus, Luker Road, Southend-On-Sea, Essex SS1 1ND


I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with East Coast Media’s Representative.

I agree to and hereby give all consents and permission and grant any licence that be required under any legislation or regulation to permit my contribution/performance to be used in whole or part in any manner by East Coast Media in all media without restriction.

My contribution will be an honest and truthful account of my experience and I confirm that I have not misled East Coast Media in any way as to my identity, experience, or as to the nature and/or content of my Contribution.


Name: James Handley


Address: 35 Walton Gardens, Hutton, Brentwood

Signed:     J.Fallon

Date: 29/01/14


Where the contributor is under 18 years of age, I confirm that I am the parent/guardian and agree my acceptance of the above on behalf of the contributor.


Signature:  N/A



PROGRAMME TITLE: Channel 21 News - Band member filmed for music VT

Date of Recording: Wednesday 29th January

To: South Essex College - Southend campus, Luker Road, Southend-On-Sea, Essex SS1 1ND

I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with East Coast Media’s Representative.

I agree to and hereby give all consents and permission and grant any licence that be required under any legislation or regulation to permit my contribution/performance to be used in whole or part in any manner by East Coast Media in all media without restriction.

My contribution will be an honest and truthful account of my experience and I confirm that I have not misled East Coast Media in any way as to my identity, experience, or as to the nature and/or content of my Contribution.

Name: Ben Miles

Address: 56 Walton Gardens, Hutton, Brentwood

Signed:     Ben.Miles

Date: 29/01/14

Where the contributor is under 18 years of age, I confirm that I am the parent/guardian and agree my acceptance of the above on behalf of the contributor.


Signature: D.Miles

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