Consent Statement for Photo/Video Submission
I grant permission to the NC Falls Prevention Coalition and the NC Center for Health and Wellness at UNC Asheville (Healthy Aging NC) and its affiliates to use my submitted photo/video and accompanying testimonial for the purposes of promoting fall prevention and healthy aging programs. I understand that my submission may be used in print, online, and other media formats as part of the Coalition's outreach and educational efforts.
By signing below, I affirm that:
The photo/video is my own, and I have the right to submit it.
This photo and video will not be used for solicitation purposes.
I voluntarily agree to the use of my image and testimonial.
I understand that I will not receive any monetary compensation for the use of my submission.
I release NC Falls Prevention Coalition and the NC Center for Health and Wellness at UNC Asheville (Healthy Aging NC) from any claims related to the use of my photo/video and testimonial.
I acknowledge that I have read and understood this consent statement.
UNCA PHOTO CONSENT;
I, the undersigned, grant permission to the University of North Carolina Asheville, its agents, employees and representatives the irrevocable and unrestricted right to take, reproduce, and publish photographs, video, audio or other impressions of me or members of my family’s image or voice for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium and to copyright the same.
I hereby release and forever discharge The University of North Carolina Asheville, its trustees, agents, officers and employees, from any and all claims and demands arising out of or in connection with the use or distribution of said media, including but not limited to, any claims for invasion of privacy, appropriation of likeness, violation of copyright, and/or defamation. Furthermore, I grant permission to use my statements that were given during an interview or guest lecture, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation or royalty or to approve or inspect the finished product, including written copy, wherein my photographs and/or video footage appears.
I have read the foregoing, and I fully understand the contents, meaning and impact of this release.