Content Release and Consent Form
Thank you for your interest in telling your story!
Health Stories Project gives people a place to share their personal health experiences and to learn from the experiences of others. Through Health Stories Project’s online community, patients and caregivers can discover the stories of people facing health challenges similar to their own, inspire others by sharing their personal health journeys, and connect with a community of people who care.
For good and valuable consideration, receipt of which is hereby acknowledged, you hereby authorize, consent, and agrees as follows:
1. HPG, LLC and its subsidiaries (including Health Stories Project, LLC) and its and their licensees, vendors, affiliates, successors, and assigns (collectively, “HPG”) may collect information about me, including video, audio and still images of my person, voice, likeness, conversations, home, furnishings, family members, pets, and surroundings (together, and including any portion thereof, “Content”), as well as video, audio, still images, writings and other media of my creation and which I voluntarily provide to HPG (“together, and including any portion thereof, “Contributions”). For purposes of this release, the term “Content” also includes text, video, audio, still photographs, and other materials based on my information or my likeness that are created and used by HPG in its promotion, advertising, publicizing and distribution activities.
2. The Content and Contributions may include descriptions of my medical conditions and records, medical procedures performed on me, and discussions with my healthcare professionals and family members (including minors) of such medical conditions, records, and procedures.
3. I confirm that any statements made by me in the Content and Contributions are true to the best of my knowledge, that the Contributions are wholly original to me and that neither my statements, my appearance nor any content contained in the Content or Contributions will violate or infringe upon the rights of any third party.
4. I agree that HPG may publish and distribute the Content and Contributions, alone or together with other promotional materials, including printed materials, interactive media such as online video networks and condition health portals, websites, CDs, DVDs, and all other forms which may be used for the publication and distribution of my information or my likeness, now and in the future.
5. I agree that HPG shall be the exclusive owner of the Content, including the materials it produces using the Content, and that HPG shall be entitled in its sole discretion and without notice to me to sub-license, sell, or otherwise convey its rights in the Content.
6. I shall remain the owner of the Contributions. I hereby grant HPG a worldwide, perpetual and irrevocable right to copy, reproduce, publish, broadcast and distribute the Contributions, in any media and format, for publishing, distributing and promoting part or all of the Contributions in any media and Content. I acknowledge and agree that HPG may sub-license, transfer or assign the rights granted herein to its affiliates, partners, successors in title and licensees and agree to do all such acts and execute such documents as HPG may reasonably require to confirm and give legal effect to these rights.
7. I agree that I will have no right to royalties, appearance fees, profit sharing, or any other form of consideration relating to the Content or Contributions or the use, publication, sale, licensing, distribution or conveyance of the Content or Contributions, in any form.
8. I understand that HPG is under no obligation to use the Content or Contributions and shall have the final decision as to use the Content and Contributions in whole or in part. I waive the right to inspect or approve any Content or Contributions in which my likeness is recognizable, or in which my medical condition(s), treatment(s), or record(s) are discussed with reference to me.
10. HPG makes no representation or warranty of any kind with respect to any medical or other advice or information that I may receive in connection with the Content and Contributions, or otherwise in connection with Health Stories Project. I confirm that I have not relied on any such representations or warranties in agreeing to participate in Health Stories Project.
11. I hereby release and hold harmless HPG and its subsidiaries and its and their officers, directors, shareholders, employees, agents, affiliates, vendors, successors, and assigns, from and against any liability or obligation in connection with loss, injury or disability related to my interest in or my participation in Health Stories Project, including, without limitation, any such loss, injury or disability that may arise in connection with the Content and Contributions or my participation in Health Stories Project.
12. I agree and understand that the provisions stated in this form will not expire or terminate.
13. I hereby acknowledge that I want to share my health experiences and provide Contributions for the purpose of creating Content. I understand that at any time I can decide that I do not want to share additional information with Health Stories Project; if I decide that I do not want to share additional information with Health Stories Project, I will tell HPG in writing that I am withdrawing from Health Stories Project. I understand that, even if I withdraw from Health Stories Project, HPG can still use the Content and Contributions that have already been collected prior to the date I withdrew my permission. I hereby waive the right to request that any of the Content be deleted, taken offline, moved, edited, retracted or redone. Where I request that my Contributions be deleted, taken offline, moved, edited or retracted, I recognize that HPG may continue to use my Contributions for up to 12 months following my withdrawal and thereafter will use reasonable efforts to remove any Contributions within its control and where physically possible.