4-5980 Churchill Meadows Blvd Mississauga ON LSM 7M5 t 905 593 1605 f 905 593 1615
clinic@muscleandjoint.ca www.muscleandjoint.ca
Photographs and Video Consent, Waiver, Indemnity and Release (Long Form)
Photographs, Videos and Recordings
I hereby grant permission to The Canadian Muscle and Joint Clinic Inc. ('The Clinic') and its representatives to take photographs or videos of me and to make recordings of my voice at the clinic
I further grant The Clinic and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings in any media now known or later developed as well as my name for promoting, publicizing or explaining The Clinic and its activities and for administrative, educational or research purposes. I acknowledge that The Clinic owns all rights to the images and recordings.
I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy.I further waive all moral rights. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials.
Ihereby release, defend, indemnify and hold harmless The Clinic from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.
Iam 18 years of age or older and I am competent to contract in my own name. I have read this document before signing below, and I fully understand the contents, meaning and impact of this consent, waiver, indemnity and release. This consent, waiver, indemnity and release is binding on me, my heirs, executors, administrators and assigns.