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In furtherance of the St. Nicholas Hospital campaign’s mission, and without expectation of c ompensation to me now or in the future, I hereby:
a) give my consent to St. Nicholas Hospital and/or its agents (i) to interview me; and/or, (ii) to make and retain, forever, reproductions incorporating: my image, voice, and/or statements. I understand that a reproduction may include, but is not limited to, an interview, film, photograph, social media feed, or recording; and, (b) I understand and agree that the St. Nicholas Hospital has sole ownership of the rights to such reproductions. Such ownership rights include the right to reproduce, distribute, publish, adapt, and create derivative works from those reproductions which may be used for any purpose worldwide in furtherance of St. Nicholas Hospital’s mission, including display to the general public.
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FOR MINORS
I hereby certify that I am the Parent or Legal Guardian of above minor, and do hereby consent and agree to be bound by the terms of the above release.
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