As a parent
(or guardian), I herby authorize________
(please initial) that photographs,
video, or quotations may be taken
or obtained of the patient or the
parent (or guardian), to be utilized
by Driscoll Children's Hospital.
Photographs, videos, and quotations
are owned exclusively and may be used
by Driscoll Children’s Hospital
and its various departments while
pursuing its mission and vision of
offering hope and healing to the children
of South Texas. Photographs, videos,
and quotation uses may include, but
not exclude:
- Collateral material (brochures,
flyers, posters, etc.)
- Editorial news stories (on television,
radio, or in newspapers or magazines)
- Website
- Commercials
- Fundraising material
- Power point presentations
- Other
I agree to release, discharge, and
hold harmless Driscoll Children’s
Hospital and its directors, officers,
employees, and agents from any and
all claims, actions, and demands of
any nature arising out of or in connection
with the photographs, videos, quotations,
or reproduction thereof.
This authorization remains in effect
indefinitely unless revoked in writing,
and is dated, signed by a parent (or
guardian) to the patient, or if the
patient has reached the age of majority.
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