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VIDEO AND INTERVIEW CONSENT AND RELEASE

I, hereby authorize (Dentech or the “Released Party”) the right and permission to copyright and/or publish, reproduce or otherwise use my name, voice, and likeness in video, photographs, written materials, and audio-visual recordings. I acknowledge and understand these materials about or of me may be used for both commercial and/or non-commercial purposes.

I understand that my image may be edited, copied, exhibited, published and/or distributed. I also understand this material may be used individually or in conjunction with other media in any medium, including without limitation to print publications, digital publications, and/or public broadcast for any lawful purpose. There is no time limit on the validity of this release nor are there any geographic limitations on where these materials may be distributed.

I hereby acknowledge and grant (Dentech) and its employees, agents, licenses, successors, and third-party organizations all ownership rights and irrevocable right and permission to use, copyright, publish, sell, distribute, and/or promote the recorded video, photo, interview, and/or audio.

I understand that my participation is voluntary and that I may, at any time, discontinue my involvement before signing this document. If I choose to discontinue participation, I will notify the principal parties (Dentech) by providing written notice by (date).

I understand that (your business name) can see no risk presently, and that I take full responsibility for my involvement in this project and the risks that it may entail (be they legal, physical, or mental) and release (your business name) from any claims, demands, losses, damages, suits, and liabilities of any kind whatsoever in connection with the foregoing.

I hereby certify that I am over eighteen years of age and am competent to contract in my own name insofar as the above is concerned. If I am under eighteen years of age, my parents or legal guardians have read this document and have given their consent by signing below.

By agreeing, I acknowledge that I have completely read and fully understand the above consent and release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for marketing, educational, promotional, and/or any other lawful purpose whatsoever.