Authorization to Use Information submitted

I grant my permission to Clearview Cancer Institute and/or the Russel Hill Cancer Foundation, to use my story, any photographs and/or video I submitted in the form above in photography, video/audio recordings for presentations, website, reproduction/printed materials, broadcast media, and social media. I further understand these materials may be used in publications, websites, electronic forms, communications, and any type of media. 

I waive any right to inspect or have prior approval to photographs, publications, or electronic matter that may be used now or in the future and I waive any right to royalties or other compensation arising from or related to the use of the photographs/information.

I hereby agree to release and hold harmless Clearview Cancer Institute and/or the Russel Hill Cancer Foundation from and against any claims, damages, or liability related to the use of my story, photographs, and/or video for the above items.