I hereby grant Jean N Banzhoff (aka Rose Jenevere), the irrevocable right and permission to use photographs and/or video recordings of me on any and all websites and social media, in publications, promotional flyers, materials, derivative works, or any other similar purpose without compensation to me.


I understand and agree that such photographs and/or video recordings of me may be placed on the Internet and on television. I also understand and agree that I may be identified by name and or title printed, Internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video, and audio recordings, and any reproductions thereof, and all plates, negatives recording tape and digital files are and shall remain the property of Jean N Banzhoff (aka Rose Jenevere) and Fairfax Public Access.


I hereby release, acquit and forever discharge agents, officers and employees of the above-named entities from any and all claims, demands, rights promises, damages and liabilities arising out of or in connection with the recording, use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.


I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less then eighteen years old, that my parent or guardian has signed this release form below. This is binding on me and my heirs assign and personal representatives.


I hereby authorize Jean N Banzhoff (Rose Jenevere)and Fairfax Public Access on behalf of Behind The Set, and those acting pursuant to its authority a nonexclusive grant to:


     (a) Record my likeness and voice on the video, audio, photographic, digital, electronic, online format or on any and all other media. 

     (b) Use my name in connection with these recordings.

     (c) Use, reproduce, publish, republish, exhibit, edit, modify, or distribute, in whole or in part,   these recordings in all media without compensation for any purpose that the Fairfax Public Access, and those acting pursuant to its authority, deem appropriate, including promotional or advertising efforts. These recordings may appear in a variety of formats and media now available to the Fairfax Public Access and Behind the Set, and that may be available in the future (e.g. print publications, videotapes, CD-ROM, Internet, mobile, digital).


I hereby release the Behind The Set and those acting pursuant to its authority from liability, claims, and demands for any violation of any personal or proprietary right I may have in connection with such use, including any and all claims for libel, defamation, or invasion of privacy.  I understand that all such recordings, in whatever medium, shall remain the property of the Fairfax Public Access and Behind The Set.  I have read and fully understand the terms of this release.


In accordance with broadcasting policies at Fairfax Public Access, any footage that is used to film Behind The Set must be kept confidential until after the air date at Fairfax Public Access. Please be prepared to wait 3 months to a year before being viewed on television or on the Internet.


The footage is not to be collected until after the show is aired unless an agreement is made with the producer. 

Selling Items or requesting membership for a company on the show is strictly prohibited, and will not be aired on Behind The Set.

Please keep any cardioid mics no less than 5 inches away from the mouth when speaking.


Please fill out the information on the next page of this sheet. By filling out this information, you are onsetting to the terms and conditions presented in this release.