Story / Photo Release Form | Emily Whitehead Foundation

RELEASE AND INDEMNIFICATION*

I agree to the following terms

1. PHOTO/RECORDING RELEASE. To support the Emily Whitehead Foundation (the “Foundation”) in its mission to raise awareness and funding for innovative childhood cancer treatments and to support families fighting childhood cancer (the “Foundation Mission”), I wish to grant the Foundation, its sponsors, subsidiaries, and affiliates, and their respective officers, directors, trustees, employees, donors, volunteers, agents, representatives, successors, and assigns (collectively, the “Released Parties”) the right to create or use stories, photographs (“Photographs”), audio recordings, or video recordings that I provide, and produce any reproduction thereof (“Recordings”), of me, my spouse, partner, and/or my child or children in connection with the Foundation Mission, and the right to copyright, publish, reproduce, or otherwise use each of my, my spouse’s, partner’s names, and/or the names of the child/ren to whom I am a parent or legal guardian, as indicated below, biography including medical diagnosis, voice, image, and likeness for promotional, documentary, charitable, educational, or any other lawful purposes, in any and all media, in any manner throughout the world, and for an unlimited number of times in perpetuity, without any expectation of financial compensation.

I waive any right that I may have to inspect or approve any finished product created or used by the Released Parties that contains Photographs and/or Recordings of me, my spouse, my partner, and/or the child/ren to whom I am a parent or legal guardian.

2. INDEMNIFICATION AND HOLD HARMLESS. I indemnify and hold harmless the Released Parties from and against any and all claims, liability, demands, actions, causes of action, costs (including counsel fees), expenses, and damages whatsoever, at law or in equity, arising out of the rights granted to the Released Parties in this Release. I acknowledge that the Released Parties will rely on this Release, potentially at substantial cost to them, and hereby agree not to assert any claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder.

I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Pennsylvania, and that any disputes arising out of this Release shall be resolved before a court of competent jurisdiction in the Commonwealth of Pennsylvania. I acknowledge that I have read and understand this Release prior to signing it. I further certify that I am eighteen (18) years of age or older.

I grant the Foundation the right to copyright, publish, reproduce, or otherwise use each of my, my spouse’s, partner’s, and/or the child/ren’s name as set forth below:*

First Name Only
First and Last Name
Other

Please specify:

Consent (as to minors)

I represent that I am the parent or legal guardian of the minor listed below and I hereby agree that we shall both be bound by the terms of this Release and Indemnification.

Name of Minor

First Last

Date

Consent*

By clicking the “Submit” button below, I hereby agree to and accept the above terms and conditions governing my or my child’s participation in the Foundation Mission.

Name*

First Last

Date*

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.

Recent News