PHOTO/VIDEO RELEASE FORM

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I grant permission and consent to Newborn Care Solutions for the use of photograph(s) and/or video(s) taken during my participation in the Elite NCS™ or Master NCS® program, as identified below for presentation under any legal condition, including but not limited to: publicity, copyright purposes, illustration, advertising, social media and web content:

Payment *

I understand that there shall be no payment for this release.

Required

Royalties *

I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

Required

Revocation *

I understand that I may revoke this authorization at any time by notifying the Releasee in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived.

Required

Signature (type name) *

Date *

YYYY

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