By completing this form I, the (parent/guardian) of the child named below, give consent and agree that WILLEN HOSPICE, its employees, or agents have the right to take images (photographs), video recordings and/or audio of the child named below and to use these in any and all media, now or hereafter known, and exclusively for the purpose of promoting WILLEN HOSPICE.
I further consent that my child’s name and identity may be revealed therein or by descriptive text of commentary.
I do hereby release WILLEN HOSPICE, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my child’s identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording my child, either for initial or subsequent transmission or playback.
I also understand that WILLEN HOSPICE is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result.