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Media Waiver

I, the undersigned, hereby consent to the use of my photograph or likeness in any publication, videotape, pamphlet or promotion, either online or in print, by Improv4health or other agencies which are promoting or furthering the mission of Improv4health. I understand that I will not receive separate compensation or consideration from Improv4health or anyone else for the permission granted in this Consent nor for the actual publication or use of my photograph or likeness. By signing this Consent, I understand I am releasing Improv4health from any and all liability that may occur as a direct or indirect result of my photograph, the release of my identity, or the public relations materials, including but not limited to the use of any quotations. 

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