Media-Marketing Consent And Release Of Liability For Photographing And/or Videorecording printable pdf download

Media-Marketing Consent And Release Of Liability For Photographing And/or Videorecording

MEDIA-MARKETING

CONSENT AND RELEASE OF LIABILITY

FOR PHOTOGRAPHING AND/OR VIDEORECORDING

I, _____________________________, hereby authorize Mercy Health on behalf of its

affiliates, including but not limited to

______________________,

(insert specific Mercy facility)

or anyone authorized by Mercy (collectively, “Mercy”), to take photographs,

transparencies, film, video and/or audio recordings or any likeness of

______________________________________________________________________.

I further authorize Mercy to use, distribute, publish or telecast any of the works for the

sole purpose of internal and/or external use by Mercy. I waive any interest in the

material.

I understand I have the right to request cessation of recording or filming. I also have the

right to rescind consent for use up until a reasonable time before the recording or film is

used.

I understand that no employee or agent of Mercy shall have any responsibility to monitor

or supervise or control any aspect of the photography or videorecording or any

subsequent use of such photographs or video.

I hereby release Mercy, its agents and employees from any liability for any and all claims

arising out of the taking of photograph(s)/video or any subsequent use thereof.

Date______________________

Signature_________________________________________________________

Print Full Name____________________________________________________

Address__________________________________________________________

Relationship to person if subject is a minor______________________________

The circumstances of the use of the literary or artistic work__________________

________________________________________________________________

Witness__________________________________________________________

Media-Marketing Consent And Release Of Liability For Photographing And/or Videorecording