For good and valuable consideration, receipt of which is hereby acknowledged and agreed, subject to the terms hereof, I authorize HEADSPACE, INC. (“Producer”) and its, affiliates, subsidiaries, licensees, successors, designees and assigns to make use of my appearance for the program tentatively entitled: “DEAR HEADSPACE” (“Program”) and in connection with Producer and/or otherwise.

1.        I agree that Producer may tape and photograph me, and record my voice, conversation and sounds, including any performance of any musical composition(s), during and in connection with my appearance, and that Producer shall be the exclusive owner of the results and proceeds of such taping, photography and recording (the “Materials”) with the right, throughout the world, an unlimited number of times in perpetuity, to copyright, to use and to license others to use, in any manner, and in all media (now known or hereafter invented), all or any portion thereof or a reproduction thereof in connection with the Program or otherwise.

2.        I further agree that Producer may use and license others to use my name, voice, likeness and any biographical material concerning me which I may provide in any and all media, and in the promotion, advertising, sale, publicizing and exploitation of the Program and/or otherwise, and ancillary products (e.g., merchandise), in connection with the Program, and/or in connection with Producer, throughout the world in any manner, an unlimited number of times in perpetuity.

3.            I represent and warrant that any statements made by me during my appearance are true, to the best of my knowledge, and that neither they nor my appearance will violate or infringe upon the rights of any third party. I hereby waive any right of inspection or approval of my appearance or the uses to which such appearance may be put. For clarity, this Appearance Release (“Release”) represents my express waiver of any and all moral rights I may have in connection with my appearance.

4.          I understand I will not be paid any compensation for giving Producer the rights listed in this Release, or for Producer’s exercise of any and all of the rights listed in this Release. I hereby waive any and all rights I may have to any such compensation. I acknowledge and agree that a significant element of the consideration I am receiving under this Release is the publicity I may receive if Producer includes the Materials in the Program.

5.          I agree to participate in the Program at my own risk and understand and acknowledge that any and all risks associated with, related to, or arising out of such voluntary participation. I appreciate the risk and danger of harm and voluntarily assume and any all such risks. I further fully and freely waive notice of, acknowledge and assume any and all dangers and risks, whether known or unknown, which may result in damage, personal injury or death, emotional distress, or reputational harm to me. I acknowledge that Producer shall not be liable for any harm or injury, whether personal, to property, reputational harm or otherwise, which I may incur by participating in physical and other activities connected with the Program unless such harm or injury results from gross negligence directly caused by or on the part of Producer.

6.          I hereby release Producer and its affiliates, subsidiaries, licensees, successors and assigns (collectively, the“Releasees”) from any and all liability, claims or expenses of any kind (collectively, “Claims”) arising from or in connection with my appearance and/or the Materials or Producer’s exploitation thereof, including without limitation any Claims based upon any alleged personal injury, death, property damage, defamation, invasion of privacy, rights of publicity, defamation, false light, intentional infliction of emotional distress, infringement of any other proprietary and/or personal rights, any physical, mental, psychological or emotional injuries and/or illness, sexual harassment, and/or negligent infliction of emotional distress regardless of whether caused by the negligence or willful or reckless misconduct of the Releasees. I will defend, indemnify and hold the Releasees harmless from any and all such Claims, as well as all those that in any way are caused by, arise out of or result from any breach or alleged breach by me of any of the representations or warranties made by me in this Release. I acknowledge that Producer will rely on this Release and all permissions granted herein, at substantial cost to Producer and therefore this Release is irrevocable. I hereby agree not to bring or assert any legal claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder.

7.          To the maximum extent permitted by law, I agree that I will never sue Producer, its licensee or any of the Releasees because I do not like the manner in which Producer took or used the Materials or portrayed me in theProgram or for any cause of action based on any of the Claims. I further agree that my sole remedy in the event of any claim against Producer shall be the recovery of damages and in no event shall I seek or be entitled to rescission, injunctive or other equitable relief. The termination of this Release, for any reason, shall not affect Producer’s rights in the results and proceeds of the taping, filming and photography and/or the Materials. This paragraph shall survive the termination or the expiration of this Release.

To the maximum extent permitted by law, I waive any and all rights I may have under Section 1542 of the Civil Code of California, and every like provision in any foreign jurisdiction. Section 1542 provides as follows:


8.          I acknowledge and agree that (a) this is a non-union agreement and that my participation and appearance hereunder shall not be subject to the terms of any collective bargaining agreement and (b) Producer is not a signatory to any collective bargaining agreement covering my participation and appearance hereunder. Producer shall not have any obligation to actually produce the Program, or to utilize my name, voice, likeness, biographical information or the Materials to exercise the rights and permissions granted herein for purposes of the Program or otherwise.

9.            All provisions hereof concerning my participation, the Materials, and the Program shall be kept strictly confidential by me and my representatives. Neither I nor my representatives shall issue any press releases or public statements about Producer, the Program or my participation hereunder, without Producer’s prior written permission. Neither I nor my representatives shall use Producer’s or any of its affiliated companies’ name, logo, trademark or other proprietary mark in any manner without Producer’s prior written approval.

10.         This is the entire agreement. This Release and the acknowledgements, representations, releases, permission and agreements made herein shall be irrevocable and binding upon me and my heirs, executors, successors, parents, guardians, licensees and representatives. Termination of this Release, for any reason, shall not affect Producer’s rights in the Materials. This paragraph shall survive the termination or the expiration of this Release. Producer may assign its rights in the Materials and/or Program, in whole or in part, to any individual or entity, without restriction.

11.              In the event that I receive any goods, services, cash prizes, or other valuable consideration by reason of my participation in the Program, I understand that I am responsible for paying all applicable taxes that may be imposed thereon, and I release and indemnify Producer from any liability therefor. I understand that the value of any such goods, services, or prizes may range from a nominal amount to $600.00 or greater. I further understand that I must submit to Producer, a properly completed IRS Form W-9.

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