PERMISSION TO USE PHOTOGRAPHS, VIDEOS AND/OR WRITTEN MATERIALS

I consent and hereby authorize Prevent Blindness and its affiliates to take, use and own and register the copyright in photographs, film and video depicting my image and/or likeness (and/or that of my minor-age child) and/or using my and/or my minor-age child’s voice for any and all purposes as determined by Prevent Blindness, consistent with its non-profit status.

I agree to permit Prevent Blindness and its affiliates to write about me or my minor-age child (including quotes) to be used for publicity purposes as determined by Prevent Blindness, consistent with its non-profit status.

I release Prevent Blindness and its affiliates from all liability resulting from or related to the taking and authorized release and/or use of the photographs, film, video, written materials, and recorded materials as described above.

I understand that I will receive no royalty or other monetary compensation from Prevent Blindness or its affiliates for permission to release or use the photographs, videos and written materials.

I hereby warrant that I have the full power to give this consent to Prevent Blindness and its affiliates. 

Prevent Blindness 225 West Wacker DriveSuite 400Chicago, Illinois 60606