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Image Consent - Release Form
I give ClinicalPRO (89 123 050 019) and its sister companies of Brisbane, Queensland, its assigns, successors, licensees, legal representatives, employees and agents (“ClinicalPRO”) the irrevocable right to use my name/photograph/image/audio recording/video recording and likeness in all forms and manner (“My Image”) for the purposes of advertising, media publicity, publication, general display or for any other business purposes in whole or in part, including but not limited to publication on social media, internet websites and print publications as released to or by ClinicalPRO or its advertising partners.
I waive any interest that I may have in the copyright to My Image now or at any future time and acknowledge that I am not entitled, nor shall in the future be entitled, to receive any payment or consideration in respect of it and agree to make no claim against ClinicalPRO for any payments for the Publication of My Image.
I understand ClinicalPRO cannot control unauthorised use of My Image by persons not associated with ClinicalPRO upon the Publication of My Image. I forever waive any right to inspect or approve any Publication of My Image by ClinicalPRO. I release and indemnify ClinicalPRO from any loss, damage, costs, expense, or claim (including consequential loss) connected with the Publication of My Image, including action for defamation, libelous material, breach of privacy, or copyright.