Photo Release
I, [pipe:9] hereby grant and authorize Kossuth Regional Health Center the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures submitted to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration.
This authorization extends to all languages, media, formats and markets now known or later discovered.
This authorization shall continue indefinitely, unless I otherwise revoke this authorization in writing.
I waive the right to inspect or approve any finished product in which my likeness appears, including written or electronic copy.
I agree that I have been compensated for this use of my likeness or have otherwise agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the photograph.
I understand and agree that these materials shall become the property of Kossuth Regional Health Center and will not be returned.
I hereby hold harmless and release Kossuth Regional Health Center from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.
Name: [pipe:9]
Date: [pipe:30]