Other names for this document: Consent for Use of Likeness. I waive any right that I may have to inspect or approve the finished product or the advertising or other copy that may be used in connection therewith or the use to which it may be applied. I do not consent. Further, I hereby affirm thatI have read th is Consent to Likeness and Release, and I fully understand the content, meaning, and impact of this agreement. copyright, use or publication of the Likeness, or the advertising copy or printed matter that may be used in connection with the copyright, use and/or publication of the Likeness. And if the image is of a minor, or an adult under the care of a guardian, you may need to obtain the permission of the parent and/or guardian. Photo consent forms are relatively straightforward. Authorization Form for Use of Child/Youth Name, Likeness, Voice and/or Photographic Image I grant permission toRisen Savior Catholic Preschool To use my child's name, likeness and/or photographic image in the production of promotional material through social media and print material. Consent form for using likeness, image, voice, performance or creative work of children or students. Get the Consent And Release Form For Use Of Likeness you want. If in doubt, consult a lawyer. I will not, directly or indirectly, endorse, speak on behalf of, or allow my name or likeness to be used to in any way promote any competitive business or competing product during my employment with the Company. Personal Release Agreement. Who Needs a Release and Right to Use Image and Likeness. Free Consent for Use of Likeness Template for Microsoft Word. The Hospital may use and release these Recordings according to my Client Consent for Recordings and Use of Likeness (attached hereto), and release personal information about me, including health information, medical history, diagnoses, medical care and treatment in accordance with such Consent and this HIPAA Authorization. Furthermore, I agree and acknowledge that neither I, nor any party related to myself, will receive any form of compensation for the use of Likeness. You can specify in the Release for Use of Likeness if this permission is is dependent on payment or not. to the KOPS/MINE to use my name and likeness to promote the KOPS program, its fiscal agent, and/or their activities. Include the particular date and place your electronic signature. Get the Consent And Release Form For Use Of Likeness you want. I do hereby waive my right to inspect, review, and/or approve PPT's Use of Likeness, and do hereby consent to allow PPT to use and subsequently reuse Likeness in materially the same form in the media of PPT's choice, in its sole and absolute discretion. The form should also have a section giving the person releasing the photo the option to revoke consent at any time. During my employment and after my employment with the Company ends, I consent to the . Complete the blank areas; involved parties names, places of residence and numbers etc. I hereby grant to COMPANY and its affiliates and assigns ("COMPANY") the right and permission to use in perpetuity, my name, likeness, image, voice, recorded voice, appearance, biographical information, statements, perfor-mance and/or testimonial(s) (collectively, "Appearance") in any manner and in any me- 1. When you need to use someone's image (for instance, a photograph or video) in a publication, like a newsletter, magazine or website, a Release for Use of Likeness gives you permission from the person in that image. If your agreement is complicated, do not use the enclosed form. This agreement shall be binding upon me and my heirs, legal representatives and assigns. Consent Form - Adult Permission to use image, video, voice, and/or creative work of adults The Department for Education develops teaching, learning and promotional materials and publishes them in print and digitally to the KOPS/MINE to use my name and likeness to promote the KOPS program, its fiscal agent, and/or . Use the Release for Use of Likeness document if: You want to use someone's likeness for almost any purpose. duplicate, distribute, or otherwise exhibit the Likeness worldwide in all forms of media and forms of exploitation, now known or hereafter created including, but not limited to, websites, film, television, radio, and print. I hereby irrevocably consent to the use of my name and likeness, including my performance, voice and image in any form, as incorporated in the Entry, by Fujitsu Computer Products of America, Inc., its parents, affiliates, subsidiaries, related companies, successors, licensees or designees and others acting on its behalf CONSENT, PERMISSION AND RELEASE FOR USE OF PHOTO, VIDEO AND/OR AUDIO I hereby give consent and permission to Rainbow Pediatrics of Palm Beach County, LLC to record the appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of the appearance of (print name) I give my consent. Declaration of consent: photographs or other images I, the undersigned, hereby consent to the use of my likeness, biography, picture and clinical details related to my person, in photographs made for the World Health Organization (WHO), as well as in publicity concerning the same. The video consent form is used to allow an organization or legal entity to use video footage of an individual with out the requirement of financial compensation. USE OF NAME AND LIKENESS. I do not give my consent. The purpose of this form is to document your consent to the Department of Veterans Affairs' (VA) request to obtain, produce, and/or use a verbal or written statement or a photograph, digital image, and/or video or audio recording containing your likeness or voice. Complete the blank areas; involved parties names, places of residence and numbers etc. I, _____, give my permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of AmeriCorps and Your AmeriCorps Program activities. CONSENT AND RELEASE FOR USE OF LIKENESS Effective as of the date shown below, approval for pase use and permission for present and future use is being granted to Golden Home Fitness, Inc of 7 Churchill Circle, Winchester, MA 01890,(email: contact@goldnenhomefitness.com), to use a photo, video or other image of This consent form for the use of photographs, digital images, and video/audio recordings is valid throughout the student's stay at the School and is not required to be resubmitted every academic year. Consent For Use of Likeness Effective as of the date shown below, approval for past use and permission for present and future use is being granted to [Insert Assignee Name] of [Insert Assignee Address] to use a photo or other image of [Insert Assignor Name]. See All ( 7) Use of Likeness. I do hereby acknowledge that I have the right to revoke this consent at any time I do hereby acknowledge that I have the right to revoke this consent at any time consent-form-use-likeness-child-student.pdf. The Entry further constitutes entrant's irrevocable permission for Sponsor, its parent companies, affiliates, subsidiaries, agents and licensees to use the Entry (in its original or edited form), entrant's name, likeness, voice and/or biographical information, in perpetuity, throughout the world, in all media and formats whether now or . Other Names for Release and Right to Use Image and Likeness. _____ ____ _____ Patient Signature Date It should have the full name and address of the "releasor" as well as the "releasee.". Declaration of consent: photographs or other images I, the undersigned, hereby consent to the use of my likeness, biography, picture and clinical details related to my person, in photographs made for the World Health Organization (WHO), as well as in publicity concerning the same. I do hereby waive my right to inspect, review, and/or approve PPT's Use of Likeness, and do hereby consent to allow PPT to use and subsequently reuse Likeness in . I hereby grant to COMPANY and its affiliates and assigns ("COMPANY") the right and permission to use in perpetuity, my name, likeness, image, voice, recorded voice, appearance, biographical information, statements, perfor-mance and/or testimonial(s) (collectively, "Appearance") in any manner and in any me- This agreement shall be binding upon me and my heirs, legal representatives and assigns. Open it using the cloud-based editor and start editing. Customize the blanks with unique fillable fields. effort to remove Likeness and Use of Likeness from the applicable media, but fully understand that PPT makes no guarantee of complete removal therefrom. associated with Likeness or the Use of Likeness, as well as for the use and disclosure of Likeness or any other protected health information associated with Likeness or Use of Likeness, in the media of PPT's choice, in its sole and absolute discretion. Contact an attorney to help you draft a release that will meet your specific needs. USE OF NAME AND LIKENESS. copyright, use or publication of the Likeness, or the advertising copy or printed matter that may be used in connection with the copyright, use and/or publication of the Likeness. Likeness Release Form I ___________________________________ hereby authorize American University to (print clearly) photograph or film me and consent to the use of my likeness and image in any and all publications, educational materials, research, marketing, advertising, news media, and Web materials. The undersigned hereby irrevocably consents to and authorizes the use by Missouri State University, its officers and employees, ("University") of the undersigned's image, voice and/or likeness as follows: The University shall have the right to photograph, publish, re-publish, adapt, exhibit, perform, reproduce . Depending on your state, a Release and Right to Use Image and Likeness may also be known as: Consent for Use of Likeness. consent and release form (image and voice) i hereby authorize the city university of new york and those acting pursuant to its authority (collectively, "cuny") to: (1) record my image, likeness, and/or voice on a photographic, video, audio, digital, electronic, or any other medium; (2) use, reproduce, modify, exhibit and/or distribute any such … The party that will use the voice or likeness is called the "Company" and the party giving the release and authorization to use his or her image is called the "Releasor.". Accessibility. The Hospital may use and release these Recordings according to my Client Consent for Recordings and Use of Likeness (attached hereto), and release personal information about me, including health information, medical history, diagnoses, medical care and treatment in accordance with such Consent and this HIPAA Authorization. This consent authorizes both any initial and any subsequent publication or disclosure of the Video, with or without my identity, at any time. I acknowledge that the University has the right to make one or more photographs, audio recordings, videotape or disk presentations, or other electronic reproductions of My Likenessin accordance with this Authorization for Use of Image, Voice, Performance, Artwork, or Likeness (hereinafter sometimes referred to simply as "this Authorization"). Release and Authorization to Record and Use Voice and/or Likeness Instructions The following provision-by-provision instructions will help you understand the terms of your release. CONSENT, PERMISSION AND RELEASE FOR USE OF PHOTO, VIDEO AND/OR AUDIO I hereby give consent and permission to Rainbow Pediatrics of Palm Beach County, LLC to record the appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of the appearance of (print name) I consent. Sample 2. I voluntarily grant to Montgomery College the absolute and irrevocable right and unrestricted permission to use my name, likeness, image, voice and/or appearance in any photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the College or its partners. 3. The purpose of this form is to document your consent to the Department of Veterans Affairs' (VA) request to obtain, produce, and/or use a verbal or written statement or a photograph, digital image, and/or video or audio recording containing your likeness or voice. associated with Likeness or the Use of Likeness, as well as for the use and disclosure of Likeness or any other protected health information associated with Likeness or Use of Likeness, in the media of PPT's choice, in its sole and absolute discretion. 1. Likeness Release Form I _____ hereby authorize American University to (print clearly) photograph or film me and consent to the use of my likeness and image in any and all publications, educational materials, research, marketing, advertising, news media, and Web materials. Customize the blanks with unique fillable fields. Open it using the cloud-based editor and start editing. Release & Consent Form I hereby give permission to [name of individual or organization] to use: Photographs Audio recordings Visual recordings . I waive any right to royalties or other compensation arising or related to the use of the materials. I consent to the Club, State Tennis organisations, TA and government and commercial partners taking, retaining and reproducing the image and likeness of me and any other person named in the 'Family' section of this application form, in any way pertaining to my membership or my or their involvement in tennis. Sample 1. Two parties might be interested in this document. Further, I hereby affirm thatI have read th is Consent to Likeness and Release, and I fully understand the content, meaning, and impact of this agreement. _____ ____ _____ Patient Signature Date duplicate, distribute, or otherwise exhibit the Likeness worldwide in all forms of media and forms of exploitation, now known or hereafter created including, but not limited to, websites, film, television, radio, and print. There is a blank space indicating the amount that the Company paid to the Releasor in exchange for the Company's right to use his or her image or recording. i hereby irrevocably consent to the use of my name and likeness, including my performance, voice and image in any form, as incorporated in the entry, by fujitsu computer products of america, inc., its parents, affiliates, subsidiaries, related companies, successors, licensees or designees and others acting on its behalf ("fujitsu") for the … optical illusion, digital alteration, use in composite form, whether intentional or otherwise, or use of a fictitious name, that may occur or be produced in the processing or publication of the Likeness. Subject area: Child safety and wellbeing. Furthermore, I agree and acknowledge that neither I, nor any party related to myself, will receive any form of compensation for the use of Likeness. Personal Data: Student name, image and likeness (photographs, films, or portraits), and voice. It should then have a description of the photo you are asking to have consent for. my likeness appears. The Releasor agrees it will have no right to approve any use of the Likeness in the Recordings or otherwise. . Document type: Form. Wednesday, September 30, 2020. The Releasor agrees it will have no right to approve any use of the Likeness in the Recordings or otherwise. Acknowledgement of Country. I, ________________________, give my permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of AmeriCorps and Your AmeriCorps Program activities. Print the likeness release form. _____ _____ signature date _____ _____ parent / legal guardian (if age 17) date. The subject must consent to the use of their image, their name, their likeness, and any statement made in whatever format the organization chooses to present them. 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