Strengthening Non-Profits/Capacity Building

For good and valuable consideration, receipt and sufficiency of which is hereby acknowledged, the undersigned individual (“Subject”) agrees with Pottstown Area Health & Wellness Foundation, a Pennsylvania general partnership, d/b/a Pottstown Area Health & Wellness Foundation and its affiliates, subsidiaries, licensees, successors and assigns, and those acting with their authority and permission (collectively “PAHWF”), and grants certain rights, as follows:

1. Subject irrevocably grants to PAHWF the unrestricted right and permission in perpetuity throughout the world to copyright and use, re-use, distribute, display, publish, republish, and copy photographic portraits or pictures, in still or moving form, of Subject or in which Subject may be included intact or in part, composite or modified in character or form, without restriction as to changes or transformations, in conjunction with Subject’s own or a fictitious name, or no name at all, or reproduction thereof in color or otherwise, made through any and all media now known or hereafter discovered for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.
2. Subject agrees that PAHWF may grant licenses to third parties throughout the world, an unlimited number of times in perpetuity, or assign or transfer any or all of PAHWF’s rights, to own or use photographic portraits or pictures, in still or moving form, of Subject or in which Subject may be included intact or in part, composite or in conjunction with Subject’s own or a fictitious name, or no name at all, or reproduction thereof in color or otherwise, made in any and all media now known or hereafter discovered for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.
3. The rights granted herein shall also include the right to edit, delete, dub and/or otherwise modify all photographs, film recordings, or captures of Subject’s image, voice, conversations and sounds, during and in connection with Subject’s appearance hereof as PAHWF sees fit in its sole discretion. Subject hereby waives any right of inspection or approval of Subject’s appearance, including the end uses to which Subject’s image, voice, or likeness may be applied.
4. Subject acknowledges that PAHWF will rely on the permissions granted herein and hereby agrees not to assert any claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder.
5. Subject hereby releases PAHWF and its affiliates, subsidiaries, officers, directors, employees, agents, representatives, contractors, licensees, and clients, and their successors and assigns, and those acting with their authority and permission, from all liability and obligations to Subject of any and all nature whatsoever arising out of or in connection with the exercise of the rights granted herein, including, without limitation, from any liability by virtue of modification, blurring, distortion, alteration, or use in composite form, whether intentional or otherwise, that may occur or be produced in the capture of Subject’s image or voice or in any subsequent processing thereof, as well as any publication thereof, including without limitation claims for libel, defamation, misappropriation, violation of Subject’s rights of privacy, including, without limitation, false light, publicity, infringement of copyright or any other right and expense respecting this release and the rights herein granted.
6. Subject certifies that Subject is not represented by any talent agent or similar representative, and no payment is due to any person in connection with the subject matter of this Agreement other than whatever fee is expressly agreed between Subject and PAHWF.
7. By checking the box, Subject hereby affirms and grant the rights set forth herein.