Image Release Waiver

I hereby grant Sidra Medicine permission to use my likeness in a photograph, video, or other digital media (Photo(s)) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all images will become the property of Sidra Medicine and will not be returned.

I hereby irrevocably authorize Sidra Medicine to edit, alter, copy, exhibit, publish, or distribute these photos or videos for any lawful purpose including publication on social media, the internet, in brochures, pamphlets, other printed advertising materials, and any other venue in including the press. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of photos or videos bearing my image.

I hereby hold harmless, release, and forever discharge Sidra Medicine and all of its agents, employees, and contractors from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have, by reason of this authorization.


Guardian Details




    I hereby accept and acknowledge the terms stipulated above: