Model Release Agreement
By submitting this video/photo and form on behalf of myself hereby consent to Connecticut Breastfeeding Coalition (CBC) and the Connecticut Department of Public Health (CT DPH) use and editing of the It’s Worth It! submission video/photo (the “video/photo”) for purposes of promoting public health through breastfeeding and associated hospital initiatives around breastfeeding (skin-to-skin, rooming-in, etc.) and/or consent to the use of your voice (actual and in text) and likeness in the It’s Worth It submission video.
Further, if your video submission is chosen as part of a final campaign, I agree to allow that video to be posted to the CBC’s and CT DPH’s websites and social media channels so that the public can benefit from the sharing of information. I also acknowledge that the CBC and CT DPH will edit the video for the above-identified purposes; I will not have the opportunity to review or inspect the edited video. It is agreed that the video or any portion thereof, edited or otherwise, shall be used exclusively by CBC or CT DPH and solely for purposes of promoting improvement in public health. It is further agreed that neither CBC nor CT DPH is required to provide any payment or other form of remuneration to me for use of the video or any portion thereof.
I am over 18 years of age and have read the foregoing and fully understand its meaning and sign this waiver (by clicking off agreement below) and release without qualification or reservation. I further acknowledge the receipt of good and valuable consideration for this waiver and release. I understand and agree to hold CBC and CT DPH, its employees, and agents, harmless from and against any claims, causes of action or liability whatsoever arising out of, during, or in connection with my participation in the video/photo campaign, and hereby release and waive CBC and CT DPH, its employees, and agents, from any and all such claims. In addition, I release CBC and CT DPH, its agents and employees and assignees from any and all claims, demands, and liabilities whatsoever in connection with the use or editing of the video.