Thursday 13 February 2014

Contributor Release Form - Channel 21 News

PROGRAMME TITLE: Channel 21 News


TX: ___________________________________________


Date of Recording: Friday 31st January




To:South Essex College, Luker Road , Southend On Sea





I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with Channel 21 News


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 Channel 21 News 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 Channel 21 News in any way as to my identity, experience, or as to the nature and/or content of my Contribution.



Name: Julie Smith


Address: 37 Bishopsteignton, Shoeburyness, Southend-on-Sea



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: ___________________________________________








PROGRAMME TITLE: Channel 21 News

TX: ___________________________________________

Date of Recording: Friday 31st January



To: South Essex College, Luker Road , Southend On Sea



I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with Channel 21 news 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 Channel 21 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 Channel 21 News 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: ___________________________________________



_________________________________________________________________________________
The MBG

PROGRAMME TITLE: Channel 21 News


TX: ___________________________________________

Date of Recording: Wednesday 29th January




To: South Essex College, Luker Road , Southend On Sea


I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with Channel 21 News 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 Channel 21 news 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 Channel 21 news in any way as to my identity, experience, or as to the nature and/or content of my Contribution.



Name: Laura Alison


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


TX: ___________________________________________

Date of Recording: Wednesday 29th January




To: South Essex College, Luker Road , Southend On Sea



I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with Channel 21 News 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 Channel 21 News 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 Channel 21 News 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


TX: ___________________________________________

Date of Recording: Wednesday 29th January




To: South Essex College, Luker Road , Southend On Sea



I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with Channel 21 News 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 Channel 21 News 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 Channel 21 News in any way as to my identity, experience, or as to the nature and/or content of my Contribution.



Name: James Fallon


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: _______________________________________






PROGRAMME TITLE: Channel 21 News


TX: ___________________________________________

Date of Recording: Wednesday 29th January




To: South Essex College, Luker Road , Southend On Sea


I confirm that I have agreed to appear in, to contribute to, or to participate in, the above recording as agreed with Channel 21 News 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 Channel 21 News 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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