Burn Survivor Holiday Party RSVP Form

CONSENT AND RELEASE OF LIABILITY* I authorize the Burn Institute to use photographs, videos and/or personal story to further their efforts to promote public awareness and support. I, or as the parent/legal guardian if the above named is a minor, permit the Burn Institute to use and publish photographs, video and/or personal story for publicity purposes including Burn Institute literature and social media. I also give permission for the Burn Institute to release such photographs, video and/or personal story to the news media and/or Burn Institute approved partners and/or conduct interviews for publication/airing to its listeners/viewers/readers. I understand that the Burn Institute is the owner of any photographs/video/personal story and or the likeness of the person identified above in perpetuity. The hereby agrees to hold harmless the Burn Institute, its officers, directors, trustees, managers, agents, and employees, from any liability resulting from or arising in connection with the taking, publication and release of the photographs or video of the undersigned pursuant to this agreement.