Contributor Release Form

PROGRAMME TITLE:         One More

Date of Recording:                  18^th May 2014, 24^th May 2014, 1^st June 2014

To:      SCN Network, Luker Road, Southend-On-Sea, SS1 1ND, United Kingdom

I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with TMP Studios 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 TMP Studios 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 TMP Studios in any way as to my identity, experience, or as to the nature and/or content of my Contribution.

Name:                                     Ashley Hodges

 

Address:                                  Tolcarne, Mill Lane, Hook End, Brentwood, Essex, CM15      0NZ

Signed:                                      Ashley Hodges

Date:                                        4^th June 2014 

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:                               Michael Hodges