I hereby grant Gunnison Valley Health System including the Senior Care Center, Home Medical Services, Hospice and Palliative Care departments permission to use my likeness and testimony in writing, a photograph, video, website, social media (including facebook) or other digital media (in any and all of its publications, including web-based publications, without payment or other consideration.
I understand and agree that all materials will become the property of Gunnison Valley Health System and will not be returned.
I hereby irrevocably authorize Gunnison Valley Health System to edit, alter, copy, exhibit, publish, or distribute this material for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness and testimony appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of said materials.
I hereby hold harmless, release, and forever discharge Gunnison Valley Health System from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
I HAVE READ AND UNDERSTAND THE ABOVE RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT: