If you would like to give permission to have your story, photos, or other materials used by Evidence Based Birth and Marnellie Bishop, Hānau Doula, please read through the following. We cannot use your story or photos unless this paperwork is filled out, signed, and submitted.

LICENSE, WAIVER AND RELEASE AGREEMENT

I. GRANT OF LICENSE. I, hereby freely and voluntarily license, consent and grant to Evidence Based Birth® LLC, a Kentucky limited liability company (“EBB”) and Internet website, and Marnellie Bishop, Hānau Doula the unlimited, perpetual, worldwide right, in the sole discretion of EBB’s and Marnellie Bishop, Hānau Doula owners, to use all of the following items of personal information of mine that I have checked and which shall be referred to collectively in this License, Waiver and Release Agreement (“Agreement”) as “My Personal Information,” in furtherance of EBB’s and Marnellie Bishop, Hānau Doula business objectives, including, but not limited to, making current evidence-based medical information on pregnancy and childbirth available to health professionals, students, and the general public:
o My personal story of my unique experience (“My Story”);
o My first name
o Video footage of my attendance at an Evidence Based Birth class
o Photograph or other digital footage of my attendance at an Evidence Based Birth class
o Other personal data I elect to provide in connection with My Story

I understand and acknowledge that by signing this Agreement, I am granting to EBB and Marnellie Bishop, Hānau Doula the right and license to use My Personal Information for any or all of the following described purposes in furtherance of EBB’s and Marnellie Bishop, Hānau Doula business objectives, throughout the world and in perpetuity: (a) reproduction, creation of derivative works, modification, publication, editing, advertising, translation, distribution, performance, and display in any print or electronic medium or media, in any form, format or forum available now or in the future; (b) posting to www.evidencebasedbirth.com and EBB’s related Internet social media and networking sites; or to hanaudoula.com and Marnellie Bishop, Hānau Doula’s social media and networking sites (c) in professional and educational presentations, lecture, online courses and other published print and electronic materials, such as, for example, E-books or case studies.

II. REPRESENTATIONS. I represent to EBB and Marnellie Bishop, Hānau Doula that the following statements concerning My Personal Information are true and accurate: (a) All photographic, video or other images and depictions of persons, and all sound recordings contained as part of My Personal Information are of me and not of any other person(s); (b) I am at least 18 years of age; and (c) All of My Personal Information is true and accurate as of the date following my signature below.

III. WAIVERS/RELEASES. I HEREBY FOREVER WAIVE AND RELEASE EBB AND HĀNAU DOULA, ITS MEMBERS, MANAGERS, OFFICERS, EMPLOYEES, AND CORPORATE REPRESENTATIVES, FROM ANY AND ALL LIABILITY FOR ANY LEGAL OR EQUITABLE CLAIMS THAT I COULD ASSERT NOW OR IN THE FUTURE FOR MYSELF UNDER APPLICABLE FEDERAL OR STATE LAWS IN CONNECTION WITH EBB’S or HĀNAU DOULA, LLC LICENSED USE OF MY PERSONAL INFORMATION GRANTED HEREIN, INCLUDING WITHOUT LIMITATION, CLAIMS FOR: (A) VIOLATION OF MY PRIVACY OR MORAL RIGHTS (INCLUDING THE RIGHT OF ATTRIBUTION); (B) COPYRIGHT INFRINGEMENT OR INFRINGEMENT OF ANY OTHER PROPERTY RIGHTS I HAVE IN AND TO MY PERSONAL INFORMATION; (C) USE OF MY PERSONAL INFORMATION ELECTRONICALLY OR OTHERWISE OUTSIDE THE SCOPE OF THIS AGREEMENT BY ANY THIRD PARTY WHO OBTAINS MY PERSONAL INFORMATION WITHOUT THE PERMISSION OR AUTHORITY OF EBB or HĀNAU DOULA, LLC, REGARDLESS OF THE MEANS OR METHOD BY WHICH IT WAS OBTAINED; (D) COMPENSATION IN CASH OR IN KIND FOR THE RIGHTS LICENSED, WAIVED AND RELEASED FREELY AND VOLUNTARILY BY ME HEREIN; AND (E) ANY INCOME DERIVED BY EBB or HĀNAU DOULA FROM ANY SOURCE WHETHER OR NOT RELATED TO EBB’S LICENSED USE OF MY PERSONAL INFORMATION.

IV. Miscellaneous. This Agreement expresses my complete understanding with respect to my rights, granted, licensed, assigned, waived and released herein, and supersedes any and all prior written and oral agreements and understandings (if any) between me and EBB, and between me and Marnellie Bishop, Hānau Doula. This Agreement is binding upon me and on my heirs, personal representatives and assigns. The terms and enforceability of this Agreement shall be governed by the laws of the Commonwealth of Kentucky. I have read this Agreement and have had a full, fair, and reasonable opportunity to ask questions concerning its terms and to evaluate the answers given personally, or in consultation with legal counsel, and I hereby set forth my signature as evidence to my full consent and agreement to such terms as my free and voluntary act.