I hereby give non-revocable consent to ChenMed Family of Companies, including but not limited to ChenMed, LLC, Chen Neighborhood Medical Centers of South Florida, LLC, Chen Tech, LLC, PMR US Holdings, LLC and Dedicated US Holdings, LLC and each of their affiliates, subsidiary and parent entity, licensees, successors, directors, officers, employees, agents, and designees (hereinafter collectively “ChenMed”) to capture my image, likeness and voice in photographs, videotapes, motion pictures, recordings or in any other media (hereinafter collectively “Images”). I further give consent to ChenMed to refer to me by name and use any quotes or testimonials that I may provide to ChenMed regarding their business or the impact thereof (“Testimonials”). I understand that such Images and Testimonials may include my medical information, which may be subsequently shared with general public, and authorize the same.
I understand and acknowledge that ChenMed will own such Images and Testimonials and further grant ChenMed permission to copyright, display, publish, distribute, use, modify, print, reprint, and create derivative works of such Images and Testimonials in any manner whatsoever for ChenMed business, including but not limited to marketing, advertising, and promotional purposes in brochures, websites, audiovisual presentations, and any other electronic displays or print materials. I acknowledge this consent to use such Images and Testimonials is being made solely for the benefit of ChenMed, and I give this consent without any expectation of compensation or other benefit to me. I further waive any right to inspect or approve the use of such Images and Testimonials by ChenMed prior to ChenMed’s use. To the extent that ownership rights in the Images and Testimonials do not automatically vest in ChenMed, I hereby assign to ChenMed all present and future right, title, and interest in all proprietary rights, including but not limited to copyright, whether now known or in the future created, throughout the world in the materials.
I hereby fully and forever release, indemnify and hold ChenMed harmless from any and all liability arising out of, related to, or in any way connected to, the use of such Images described herein, in any manner or media including but not limited to from any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur in the taking, processing, reduction, production, publication or distribution of such Images. Further, I covenant and agree not to sue, or otherwise initiate any legal proceedings against ChenMed, arising out of ChenMed’s use of such Images and Testimonials, and I waive any and all claims, actions, suits, demands, costs and expenses relating to ChenMed’s use of the Images and testimonials, including, without limitation, for the invasion of privacy rights, defamation, false light, or publicity.
I confirm that I am 18 years of age or older, I am competent to contract in my own name, and that I have not given anyone the exclusive right to use my name, portrait, picture, likeness, or quote. I have read this document before voluntarily signing below. I fully understand the content, meaning and impact of this authorization, waiver, disclaimer, indemnity and release, and that this authorization, waiver, disclaimer, indemnity and release is binding on me, my heirs, executors, administrators and assigns.
