I do hereby consent to the photographing, videotaping and/or use of my identity in association with any production, print, TV, or web based media for Fort Hudson Health System. I understand that my likeness and/or my story may be used in publications, press materials, web, or advertising produced for Fort Hudson Health System, or any affiliated corporations or programs.
I further release this organization, its affiliates, their directors, officers, employees, agents, and members from any liability, claims or causes of action, including but not limited to those asserting the violation of a property interest or privacy interest in connection with the above stated activity. I understand there will be no compensation provided to me, or my representatives, for use of my likeness or story. *