Media Consent:*: By submitting this form, I hereby give my consent and authorization to Nicklaus Children’s Health System, Nicklaus Children’s Hospital, and Nicklaus Children’s Hospital Foundation, including its physicians, authorized technicians, employees, and authorized agents (collectively “NCHS”) to photograph, film, create digital images, video, interview, create sound recordings, or otherwise create media content (“Content”) of me child related to the iHeart4Kids Radiothon event. I understand that such media content may include my face, image, likeness, voice, name and age.
Marketing or Media Purposes*: The Content may be used by NCHS for internal and external marketing, public relations, communications, and promotional purposes. Disclosures may be made to national and local reporters, television programs, news agencies, radio stations, internet, and social marketing or media sites. I hereby consent to and specifically authorize NCHS to disclose and use such Content as indicated above and in Media Consent.