Photography/Video Release Agreement

I hereby give to Catalina Island Health/Catalina Island Health Foundation, its legal representatives, with any of their brands, subsidies and related marketing efforts and assigns:

a) the unrestricted right and permission to take, edit, alter, copy, exhibit, use, re-use, publish, distribute and republish photographic portraits, pictures or video taken of me, or in which I may be included intact or in part, composite or distorted in character or form, in any and all lawful media now or hereafter for promotion, education, information, advertising, or other marketing including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, television, social networking sites, and other print and digital communications, without payment or any other consideration.

b) I hereby relinquish any right that I may have to examine or approve the completed product or products in which my photos or videos are used or the advertising copy or printed or electronic matter that may be used in conjunction therewith or the use to which it may be applied.

c) I hereby release, discharge and agree to save harmless Catalina Island Health/Catalina Island Health Foundation, the photographer, his/her heirs, legal representatives or assigns, and all persons functioning under their permission or authority, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture(s) or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

d) I agree that the above mentioned photographs/video and any reproductions may or may not include my name and understand that if my name is not used it is still possible that someone may still recognize me. I further agree that Catalina Island Health/Catalina Island Health Foundation or any person authorized by or acting on its behalf may use the above mentioned photographs/video or any reproductions of them for any advertising and marketing purposes or for the purpose of illustrating any wording, and agree that no such wording shall be considered to be attributed to me personally unless my name is used.

e) I hereby affirm that I am over the age of majority and have the right to contract in my own name and/or that I am signing on behalf of minors who are my children or of whom I hold legal guardianship. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

By consenting to the release of images and video footage, you agree that you will not receive any form of compensation in cash or in kind.

Your refusal to consent to the release of your photographs will not, in any way affect the medical care you will receive.