(please print name), for valuable consideration, receipt of which is hereby acknowledged, agree to be photographed, filmed, videotaped and/or recorded by Theta Wave Fitness LLC and/or representatives of Theta Wave Fitness LLC. I hereby grant and assign to and its subsidiaries, successors, agents and assigns (collectively referred to as the “Released Parties”), my rights including but not limited to the use, reuse, reproduction, modification, publication, display, transmission and performance in any and all media now or hereafter known of my name, photograph(s), statements made by me, motion pictures, videotape, audio recordings, internet postings or other web publications, or other likeness of me, alone or with other persons (“Publicity Rights”) and for the purpose of advertising and/or promoting or otherwise exploiting the services and products of the Released Parties or any of them(“Publicity Rights”
On my own behalf, and on behalf of my heirs, executors, administrators, successors and assigns, I release and discharge the Released Parties from any liability by virtue of the exercise of their rights in the Publicity Rights, including without limitation any blurring, distortion, alteration, optical illusion, or use in composite form that may occur or be produced regarding the use of my name or the taking of said photograph(s), statements made by me, motion pictures, videotape, recordings, internet posting or other web publication, or other likeness of me in any processing thereof through completion of the finished product, and including without limitation any liability based on rights of publicity, invasion of privacy and other civil rights, moral rights, copyright infringement, defamation, libel and slander. I waive any right that may have to inspect or approve any uses made of the Publicity Rights in connection with this consent/release.
I understand that I will not receive any royalty or other monetary compensation, now or in the future, for my Publicity Rights including but not limited to the use of my photograph(s), statements made by me, videotape, or other likeness or reproductions of me and recordings.