I hereby consent to and authorize the use and reproduction, in print or electronic format by the KCNT1 Slack Epilepsy Foundation (KEF) and its beneficiary agencies, to use all and/or part of my story, video, or photo for promotional and educational uses, without compensation. I attest that I am the parent or legal guardian of the children in the videos and photos and that I have the authority to authorize KEF to use their photographs and first names. I expressly release KEF its agents, employees, licensees and assigns from and against any and all claims which I have or may have for invasion of privacy, defamation or any other cause of action arising out of production, distribution, broadcast or exhibition of the materials, films, website content, promotional materials. I give permission to the KCNT1 Epilepsy Foundation to use such a story about me, with or without my name, for any lawful purpose including, but not limited to: publicity, donor solicitation, advertising, and social and website content.

I agree that my User Content/materials may be edited at the sole discretion of KEF and its agents, including sound effects, special effects and music; to use and to license others to use such recordings and photographs in any manner or media whatsoever, including without limitation unrestricted use for purposes of publicity, advertising and sales promotion.

I further agree that participation in any publication and website produced by KEF confers no rights of ownership whatsoever. I release KEF, its officers, trustees, volunteers, and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children. (In the next section, please provide names of the persons who are in any of your photos.)

To request that your child’s photo(s) or other User Content be removed from the website and use in new materials, please submit a written request by email to info@kcnt1epilepsy.org and allow a reasonable time thereafter for a response.

I have read this release before signing below and I fully understand the contents, meaning, and impact of this release and agree to the above.

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