Video Consent and Release Form

Without expectation of further compensation or other remuneration, I hereby freely give my consent to CoverAlls Decals, to use my image and likeness and/or any interview statements to be used in its publications, advertising and/or social media activities.

This consent is given exclusively in the promotion and/or marketing of CoverAlls Decals in perpetuity, without prior approval by me.

This consent includes:

(a) Permission to use part or the entirety of this video in an interview, film, photograph, tape, or other video reproduction of me and/or record my voice;

(b) Permission to use my name; and

(c) Permission to use quotes (or excerpts of such quotes) from the video, interview, the film, photograph(s), tape(s) or reproduction(s) of me, and/or the recording of my voice in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.

This consent takes effect as of the date of the media creation.