I (the undersigned) hereby grant to Saint Luke’s Health System and its subsidiaries and affiliates (“you”) the right to photograph or video me, or my minor dependent, and to record my voice, performances, poses, actions, plays and appearances, and use my name, image and likeness and other personal characteristics in connection with the materials tentatively entitled (Picture name below, the "Picture").
I hereby irrevocably permit, authorize, grant and license you, and your successors, and assigns, and the employees, officers, directors, and agents of each of them, the perpetual right to display, exhibit, use, transmit, broadcast, digitize, modify, edit, reproduce and publicize all still and motion pictures and sound track recordings and records which you may make of me or my voice, and the right to use my name and/or likeness in connection with the exhibition, advertising, exploiting and/or publicizing of the Picture and for other commercial and business purposes. I further grant you the right to reproduce in any manner whatsoever any recordings including but not limited to all instrumental, musical, or other sound effects produced by me in connection with the production and/or postproduction of the Picture. Any credit or other acknowledgement of me, if any, shall be determined by you in your sole discretion.
In exchange for the intangible value I will gain by participating in the Picture and other good and valuable consideration, the receipt and sufficiency of which I acknowledge, I agree that I will not assert or maintain against you, your successors, assigns and/or licensees, any claim, action, suit or demand of any kind or nature whatsoever, including but not limited to those grounded upon invasion of privacy, rights of publicity or other civil rights, or for any reason in connection with your authorized use of my story, medical history, and/or my patient information.
If I am your employee and also a volunteer, I acknowledge that I have no expectations of payment (monetary or other) or employee benefits for personal time I choose to spend as a volunteer.
I represent and warrant that I am at least 18 years of age and I have fully right, power, and authority to grant the rights described in this release.