Media Consent and Release
It’s your story.
Would you consider sharing it with us?
Stories like yours enable us to serve more women and their families in South Hampton Roads. Sharing your story is absolutely your decision. If you choose not to share your story with us, you will still have access to the resources and benefits you currently have through our programs or services. That said, we’re not promising “additional” resources or benefits from us for sharing your story.
Some reasons why we are asking for your story:
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- To encourage and inspire other future clients
- To educate our audiences and increase their understanding of our work.
- To inspire audiences to support our work by donating money, volunteering, or advocating for our cause.
Some ways that we might use your story:
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- We may or may not tell your full story or share every detail you provide us.
- We may add context around your story to enhance our audiences’ understanding.
- We may make editorial or grammatical edits to your story to facilitate the best and most proper use for the format selected.
- We may share your story, your image, or parts of your story in multiple formats such as print material, websites, videos, email, and social media.
Our audience may include:
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- Other organizations that work with us.
- Donors (institutions, companies, churches, individual supporters, etc.) who support our work by providing funding and other resources.
- Media, including (but not limited to) print, audio, video, online, newspapers, magazines, TV, internet publishers, social media, and radio.
Our promise to you:
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- We will strive to represent your story and likeness authentically.
- We will not sell your story and/or images to any other party for their production purposes unless your written permission is obtained.
Definitions
The Keim Centers and the Crisis Pregnancy Center of Tidewater, Inc. are collectively referred to as the “Organization” in the following paragraphs.
Employees, officers, agents, representatives, assigns, successors in interest, licensees, and legal representatives of the Organization are collectively referred to as the “Partners” in the following paragraphs.
Interviews, photographs, audiotapes, videotapes, written stories, quotations, any other recording or depiction of me and/or my child, the products thereof, and my and/or my child’s names are collectively referred to as the “Data” in the following paragraphs.
Permissions
I authorize the Organization to interview, photograph, audiotape, videotape, and otherwise record me and my child.
I grant and assign the Organization and its Partners all rights of every type and nature to the Data. Without limitation, the Organization shall have the right to edit the Data and use the Data in promotion, advertising, exhibition, fundraising, education, commerce, and for any other lawful purpose in perpetuity throughout the world until such time as I withdraw my consent.
If I choose to withdraw my consent, the Organization shall not engage in new uses of the Data. The Organization shall not, however, be required to stop using the Data for products commenced before I withdraw my consent.
Acknowledgements and Waivers
Copyrights – I understand and acknowledge that all materials created using the Data will be the property of the Organization and may be copyrighted by it.
Royalties – I understand and acknowledge that I will not receive any monetary compensation for the permissions I am granting herein. I release the Organization and its Partners from all claims that I or any of my representatives may have now or in the future to compensation arising from use of the Data or related thereto and waive any right to any royalties arising from any of these efforts.
Inspections and Approvals – I hereby waive any right to inspect or approve any finished product that uses the Data, including, without limitation, written copy, and any other uses to which the Organization may put the Data.
Claims, Damages, Etc. – I understand and acknowledge the Organization will rely on this permission and hereby release and discharge the Organization from any and all claims, demands, damages, liabilities, causes of action, costs, and expenses that may arise from collecting or using the Data in accordance with the provisions of this Media Consent and Release. This release includes, but is not limited to, any and all claims for libel, invasion of privacy, or emotional distress.
Right to Revoke
You have the right to change your mind at any time and revoke your consent to the extent described below. If you inform us, we will not use your story or likeness in new communications after you revoke your permission. However, we will not be obligated to withdraw images and stories already published. If you wish to revoke your consent, please notify us in writing at: CPCOT, PO Box 119, Norfolk, VA 23501; or at: info@cpcot.org.
Authorization and Signature
I have fully read and understand this Media Consent and Release; am fully familiar with its contents, meaning, and impact; and hereby freely and voluntarily agree to its provisions on behalf of myself and my child whose name is listed below (if any). I certify that I have granted this permission and release under my own free will. I understand that the provisions of this Media Consent and Release are legally binding. I also agree that photocopies, facsimile, electronic, and other copies of this document shall have the same effect for all purposes as an ink-signed original.
Furthermore, I am 18 years of age or older and the parent or legal guardian of the minor individual named below (if any), and I hereby sign this Media Consent and Release on behalf of myself and such minor: