Media and Photography Release

I hereby grant Teen Health Connection permission to use, re-use, exhibit, distribute, or publish my and/or my child’s testimonials, images, artwork, portraits, pictures or videos for any Teen Health Connection purpose including but not limited to Teen Health Connection illustrations, art, videos, promotional materials, editorials, advertising, publications, websites or web content, all without any compensation. I understand that any images, videos or artwork may be used at exhibits and may identify me and/or my minor child. I relinquish any right that I may have to inspect, examine or approve any completed product or products or any written or electronic copy or other printed matter that may be used in conjunction with any of the foregoing. I understand and agree that all materials containing the images or artwork of me and/or of my minor child shall become the property of Teen Health Connection. I hereby release, discharge and agree to forever hold harmless Teen Health Connection, its legal representatives or assigns, and all persons or entities functioning under its permission or authority from all and any claims, demands or causes of action ensuing from or in connection with the use or publication of any of the foregoing including without limitation any claims for libel or invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of Teen Health Connection and shall be binding upon me and upon my estate, my heirs and my legal representatives. I have read and fully understand the content, meaning and impact of the forgoing and represent that I am the individual named below. I agree that I am over the age of majority or that I am the parent or legal guardian of the minor child named below, am over the age of majority, and hereby consent to the foregoing on behalf of such minor child named below.

 

I agree to take part in [describe what involvement the individual will have e.g. an interview] and for the information I provide to be shared with the [area] Partnership agencies and this in turn allows services that I use to share information about me and my family for the purpose of this [research / activity]. I understand that I need to inform the other members of my family that I have given consent which will allow them to opt out if they wish. I understand that anonymized [information / research] about me and my family may be published within the [project report / relevant document], which may be published online and that published material from this [project / report] may be used and distributed for training and service design and development. I know that my participation is voluntary and that I can choose to withdraw from the research at any point.