For good and valuable consideration, receipt of which is hereby acknowledged, I hereby authorize Springfield Clinic, LLP (“Clinic”) to make use of my appearance for use on its social media platforms, website, internal communications and advertising as it relates to my employment with the organization.
I agree that Clinic may tape and photograph me, and record my voice, conversations and sounds and that Clinic shall be the exclusive owner of the results and proceeds of such taping, photography and recording with the right, throughout the world, an unlimited number of times in perpetuity, to copyright, to use and license others to use, in any manner, including but not limited to: television, print media or the Internet.
I further agree that Clinic may use and license others to use my name, voice, likeness and any biographical material concerning me that I may provide, in any and all media, including but not limited to television, print media and the Internet, whether now known or hereafter discovered, in the promotion, advertising, sale, publicizing and exploitation of the Project and ancillary products in connection with the Project and in connection with Clinic and Clinic’s affiliated services, throughout the world and in any and all media, including the Internet, whether now known or hereafter discovered, an unlimited number of times in perpetuity.
I further represent that any statements made by me during my appearance are true, to the best of my knowledge, and that neither they nor my appearance will violate or infringe upon my rights or those of any third party, including my privacy rights under HIPAA or any other federal or state privacy law.
I hereby waive any right of inspection or approval of my appearance or the uses to which such appearance may be put. I hereby acknowledge that I am solely responsible for any statements made by me during my appearance in these images or videos, which statements shall consist solely of my opinions and do not necessarily represent those of Clinic, who is not responsible for the contents of such statements.
I hereby release and hold harmless the Clinic, its officers, directors, shareholders, employees, agents, affiliates, successors, and assigned, and their affiliates, from and against any liability or obligation in connection with loss, injury or disability, including without limitation, any such loss, injury or disability that may arise in connection with the use of these images or videos.