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Media and Statement Release Form
I hereby irrevocably grant SmileOnU its affiliates, licensees, agents, employees, predecessors, successors and assigns (collectively, “SmileOnU”), the unrestricted right to use, reuse, publish and republish my likeness/ quote(s)/ statement(s), and/or demographic information such as age, place of residence, and/or practice specialty (or those of the minor named below contained in photograph(s)/ video(s)/ quote(s)/ statement(s) (hereinafter collectively referred to “content”) taken by photographer(s)/ videographer(s)/ interviewer(s), and to distribute such content for editorial, trade, advertising or other purposes in any manner or medium, including, but not limited to, film, videotape, audiotape, photograph, television, radio, digital, internet, theatre, or exhibition, whether now or hereinafter known, throughout the world in perpetuity, without compensation to me of any kind.
I agree that SmileOnU shall own all right, title and interest to the content and I waive any right to inspect or approve any use of the content. I understand that the content may be edited, but will continue to reflect the original meaning. I expressly release, forever discharge and agree to hold harmless SmileOnU from and against any and all claims, demands and causes of action which I have or may have for invasion of privacy, right of publicity, defamation, claim of visual or audio alteration or granted, even if the use of the content is objectionable to me.
I warrant that I am over the age of eighteen (18) and I am competent to contract in my own name.