I hereby give Henry County Medical Center (HCMC) and its affiliates permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of HCMC.
I agree that HCMC has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with HCMC’s business. These uses include, but are not limited to social media, digital media and print media; and any promotional or educational materials in any medium now known or later developed, including the Internet and Intranet.
I acknowledge that I will not receive any compensation for the use of such pictures, etc., and hereby release HCMC and its agents and assigns from any and all claims which arise out of or are in any way connected with such use. I further understand that I may not be informed in advance of the specific use of my image and that I may be identifiable from this media. I understand that this consent will stay in effect indefinitely unless revoked by me in a written statement to HCMC.
I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.