Media and Photo Release Form Media Release Form Date MM slash DD slash YYYY Consent(Required) By checking this box, I am acknowledging I have read and I am agreeing to the terms of the media release below.COMMUNITY HEALTH CENTER ASSOCIATION OF MISSISSIPPI (CHCAMS) Talent and Recorded Content Authorization and Release I hereby grant permission to Community Health Center Association of Mississippi (CHCAMS) and its employees, agents, representatives, and assigns (hereinafter "CHCAMS") to photograph or videotape my image, likeness, or depiction and/or that of my minor children (if applicable). I hereby grant permission to CHCAMS to edit, crop, or retouch such photographs, and waive any right to inspect the final photographs, video, sound recording, multimedia project (recorded content). I hereby consent to and permit recorded content of me and/or those of my minor children to be used by CHCAMS worldwide for any purpose, including educational, promotional and advertisement purposes, and in any medium, including print and electronic. I understand that CHCAMS may use such recorded content by digital devices or from interview notes with or without associating names thereto. I further waive any claim for compensation of any kind for CHCAMS’s use or publication of photographs of me and/or those of my minor children (if applicable). I hereby fully and forever discharge and release CHCAMS from any claim for damages of any kind (including, but not limited to, invasion of privacy; defamation; false light or misappropriation of name, likeness or image) arising out of the use or publication of photographs of me and/or those of my minor children (if applicable) by CHCAMS, and covenant and agree not to sue or otherwise initiate legal proceedings against CHCAMS for such use or publication on my own behalf or on behalf of my minor children. All grants of permission and consent, and all covenants, agreements and understandings contained herein are irrevocable. I acknowledge and represent that I am over the age of 18, have read this entire document, that I understand its terms and provisions, and that I have signed it knowingly and voluntarily on behalf of myself and/or my minor children (if applicable). 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