I hereby grant the Lucile Packard Foundation for Children's Health permission to use my likeness in a photograph or video in any and all of its publications, including but not limited to all of Lucile Packard Foundation for Children's Health's printed and digital publications. I understand and agree that any photograph using my likeness will become property of the Lucile Packard Foundation for Children's Health and will not be returned.

I acknowledge that since my participation with the Lucile Packard Foundation for Children's Health is voluntary, I will receive no financial compensation.

I hereby irrevocably authorize the Lucile Packard Foundation for Children's Health to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing the Lucile Packard Foundation for Children's Health's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

I hereby hold harmless and release and forever discharge the Lucile Packard Foundation for Children's Health from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.