hereinafter referred to as "the filmed person" and Speak UP! Botermarkt 9F, 2011 XL Haarlem, hereby declare to have agreed as follows:
1. The filmed person declares to be aware that photos or video recordings are made on the said event date in which he / she may be recognised and therefore unconditionally agrees to waver all copyright concerning the images still or in motion. Further more, the filmed person acknowledges the privilege that Speak UP! has to deviate from the actual recording still or in motion, or to supplement and / or change it.
2. The filmed person hereby grants Speak UP! unconditionally the right and the permission to make recordings of his / her performance in the context of the aforementioned video, to make it public, whether or not in edited form, to reproduce, deliver or otherwise distribute or disseminate in the to bring traffic, or to offer it for those purposes or to have it in stock, to send it out, to have it repeated, or to have it repeated, or to otherwise exploit it in any way known today or in the future.
3. That the rights arising from the cooperation, including any Copyrights and Related Rights are hereby fully transferred to Speak UP !.
4. The person photographed or filmed agrees that he / she receives no financial compensation for the photographs and or recordings made by Speak UP! .
5. By signing this agreement, the filmed person declares that he / she has been well and sufficiently informed  of the nature of the photos / video as well as the conditions under which they are being made by  Speak UP! 
Date
For approval:
If you are a minor ( under 18 ) please add name parent or guardian:
Signature (use the mouse or your finger):