VIDEO AND PHOTOGRAPH/IMAGE RELEASE AND CONSENT AGREEMENT
I, for myself and on behalf of my heirs, successors and assigns, hereby irrevocably and perpetually grant to the California Breastfeeding Coalition (CBC) and the California WIC Association (CWA):
a) My consent and the right and permission to take, use, re-use, publish, and republish videos, photographic portraits, or pictures of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium, and in any and all media now or hereafter known, specifically including but not limited to print media and distribution over the internet, intranet, and extranet for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever.
b) My consent and the right to copyright interest in any Works created, provided, developed or produced under the agreement and ownership of any Works not fixed in any tangible medium of expression and agrees to assign those rights to the CBC and CWA. For any Works for which the copyright is not granted to the CBC and CWA, the CBC and CWA shall retain a royalty-free, non-exclusive and irrevocable license throughout the world to reproduce, to prepare derivative Works, to distribute copies, to perform, to display, or otherwise use, duplicate or dispose of such Works in any manner for government purposes, and to have or permit others to do so.
I specifically consent to the digital compositing or distortion of the videos, portraits or pictures, including without restriction any changes or alterations as to color, size, shape, perspective, context, and foreground or background. I also consent to the use of any published matter in conjunction with such photographs. I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection with them or the use to which they may be applied.
I agree that the CBC and CWA will own any and all rights in any materials developed using the information.
I release the CBC, CWA, its employees, contractors, agents, successors, and assigns from any and all liabilities, claims and demands arising out of or in connection with their use of the videos, photographic portraits or pictures of me. I understand that my eligibility to participate in any CBC and CWA program will not be affected if I choose not to sign this authorization form. I hereby agree that the CBC and CWA may exercise all or any of the rights herein granted by me without claims, demands or causes of action at law or in equity, whether for libel, defamation, violation or right of privacy, or infringement of any literary or other property right or otherwise.
I hereby warrant that I am a legal competent adult and a parent or legally appointed guardian of the minor named below, and that I have every right to contract for the minor in the above regard. I state further that I have read the above authorization, release, and agreement, prior to its execution, and that I am fully familiar with the contents of it. This release shall be binding upon the minor and me, and our respective heirs, legal representatives, and assigns.