By my signature below, I hereby authorize LCMC Health and its affiliates to disclose to media representatives or otherwise publish, online or in print, information about my experience as a volunteer at an LCMC Health facility.
For purposes of public relations, marketing, education, fundraising, or in response to news or media inquiries. This authorization includes my likeness on photo, video, and digital media.
I understand that:
- I understand that by signing this authorization, the disclosed information enters public domain.
- I understand that this authorization will remain in effect until revoked. I may revoke this authorization at any time by contacting the LCMC Health Marketing Department. My revocation will take effect upon receipt.
- I understand that if my consent is revoked LCMC Health will make reasonable efforts to remove previously released information from its electronic platforms. I understand that information released prior to this revocation may have been printed and/or electronically released to public platforms that are irreversible.
- I have a right to receive a copy of this authorization upon request.
- I may refuse to sign this Authorization. My refusal will not affect my ability to obtain treatment or payment or eligibility for benefits.
- If I am an employee of LCMC Health or one of its member hospitals, subsidiaries, or affiliated entities, I understand that I may refuse to sign this Authorization, and my refusal will not affect the terms and conditions of my employment.
- I may request cessation of filming or recording at any time.
- I will not receive financial compensation.
