I’M THE EVIDENCE /MENTAL HEALTH CAMPAIGN
PHOTO/VIDEO RELEASE FORM

I/We authorize the Mental Health Association in Pennsylvania (MHAPA) and I’m the Evidence/Mental Health Campaign (ITE/MH) to use the photo I’ve/we’ve submitted to the ITE/MH Campaign in any media, including but not limited to the ITE/MH Campaign blog, social media pages, public art exhibition and publicity materials.

I/We confirm that I/we know the nature of the project and hereby assign all my/our intellectual property rights or any other right that could limit the ability of above parties to use images. I/we understand that the ITE/MH Campaign may alter my/our photo to fit the format and size requirements of its media properties.

I/We hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me/us or unknown, and I/we waive any right to royalties or other compensation arising from or related to the use of the photograph.

I am/We are 18 years of age or older and competent to contract in my/our own name(s). I/We have read this release before submitting my/our photo to ITE/MH and fully understand the contents, meaning and impact of this release. I/We understand that I am/we are free to address any specific questions regarding this release prior to signing, and agree that failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

 

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