I give Alcove Health, and its affiliates, permission to use my photo and/or video and/or that of my minor child, if included, all or part of my story to make derivative works, without personal identification unless authorized, for illustration, promotional materials, fundraising campaigns, marketing, and/or promotion of Alcove Health, its affiliates, and/or in any medium. I understand that my testimony may be used to encourage others who are in a similar situation or to encourage financial supporters of the clinic or to promote awareness and fundraising support for the organization.
I understand that "any medium" includes, but is not limited to, things like the internet, social media, YouTube videos, print materials, and the likes. By signing this release, I understand Alcove Health may allow others to use my photo/image, quote, and/or story in any way that Alcove Health could use it.
I waive any claims that I may have arising from such use. There are no restrictions on use unless I have specified them below.