Starlight Children's Foundation (“Starlight”) is grateful to patients, families and/or campaign participants willing to share their images and stories.
Information about the experiences patients had, can prove enormously helpful to understanding the positive impact of Starlight’s programs. At the same time, the privacy of patients, families and their visitors, as well as the confidentiality of medical and related information, are among our highest priorities. Permission is always sought from patients, their families, or guardians before we provide names, photos and information about hospitalization and treatment. This document constitutes permission from a parent or guardian of a patient for Starlight and the parties mentioned below to record, disclose, or use such information.
By signing this document, for good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby agree as follows, for and on behalf of myself and (if applicable) the patient identified below (“we” or “us”), whom I represent and warrant that I have the right and authority to represent:
Each of Starlight and any of its contractors, partners, sponsors and donors (including Disney Worldwide Services), and its and their respective affiliates, and any employees, agents, and representatives of any of the foregoing, and any successors, assignees, and licensees of any of the foregoing (collectively, the “Released Parties”) may photograph, film, videotape, record and otherwise capture (collectively, “Record”) the name, image, physical likeness, performance, voice, personal characteristics, biographical data and other personal identification of each of us and any statement that any of us may make regarding or relating to any Released Parties (collectively, “Personal Information”).
We hereby grant each Released Party the irrevocable, perpetual, unconditional, royalty-free, transferable, assignable, sub-licensable, worldwide and unrestricted rights to use, reproduce, copy, distribute, host, modify, publicly perform or display, translate, and create derivative works of any work (including photographs, audios, videos, essays, personal stories, artwork) including any Personal Information as Recorded and any work provided to any Released Party by, for or on behalf of any of us (collectively, the “Materials”), in any medium or format now known or hereafter devised and for any purpose, including but not limited to promotions, publicity, and advertising of the Released Parties. We hereby waive the right to inspect or approve the Materials. I represent and warrant that (i) we have the right to provide the Materials and to grant the rights purportedly granted herein; and (ii) the use of the Materials and the exercise of the rights granted herein does not and will not conflict with any obligation that any of us owes to any third party, or infringe, misappropriate or otherwise violate the rights of any third party. I understand that the Released Parties may proceed in reliance on this document, but shall be under no obligation to use or disclose any Materials for any purpose or otherwise exercise any of the rights granted to them herein.
I acknowledge that I might receive at $30.00 gift card only if the submitted materials are deemed usable. Submitting materials does not guarantee receiving a $30.00 gift card, nor does it guarantee Starlight will use any submitted materials. Starlight reserves the right to cease offering any $30.00 gift card at anytime for any reason, with or without notice.
I also acknowledge that, as between Starlight and “us,” Starlight shall own all right, title, and interest (including, without limitation, the copyright) in all Materials and any works created by, for or on behalf of Starlight and/or any other Released Party that include any Materials, in whole or in part. We hereby waive and release all Released Parties from any and all claims or demands we may now, or in the future, have, arising out of, or in connection with, this document, their exercise of the rights granted herein, and their use of the Materials, including, without limitation, any claims respecting invasion of privacy, copyright infringement, right of publicity, defamation and any other personal and/or property rights.
I have read the foregoing and fully understand the contents thereof.