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Media Release

Online Media Release Form

For good and valuable consideration, the adequacy and receipt of which is hereby acknowledged, I, the undersigned, hereby grant Mustang Forces permission to use my likeness in a photograph, video, or audio in any and all of its publications, including but not limited to all of Mustang Forces printed and digital publications. I understand and agree that any photograph using my likeness will become property of Mustang Forces and will not be returned.


I acknowledge that since my participation with Mustang Forces is voluntary, I will receive no financial compensation.


I hereby irrevocably authorize Mustang Forces to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Mustang Forces' programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.


I acknowledge that Mustang Forces is committed to safeguarding my medical privacy and confidentiality. While Mustang Forces will not release my medical information without my express permission, lawful order, or when necessary to ensure my health and safety in emergency medical situations, I acknowledge that the use of my likeness in Mustang Forces media may imply my participation in mental healthcare-related treatment or activities. If such implication is later construed as a release of my medical information under the Health Insurance Portability and Accountability Act (HIPAA) and other applicable law or regulation, I confirm that this agreement represents my express permission for said release.

Confirmation of Understanding
I understand the use of my likeness in Mustang Forces media may imply my participation in mental-healthcare related treatment or activities.

I hereby hold harmless and release and forever discharge Mustang Forces 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.


PARENT/GUARDIAN CONSENT. I am the parent/guardian of the minor named in the box below labeled "Named Minor" box who resides at the address described in the following box below labeled "Minor's Residence" and whose birthdate is described in the following box labeled, "Minor's Birthdate." I consent and agree on behalf of the named minor to all of the terms and conditions of this Agreement. By signing this Media Release, I represent that I have legal authority over and custody of the named minor.

I HAVE READ THIS DOCUMENT, UNDERSTAND ITS CONTENTS, AND, BY SINGING IT BELOW, I EXPRESSLY AGREE TO BE BOUND BY THE ENTIRETY OF ITS TERMS.  


I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

Date
Birthdate
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