I, give my permission to E-telmed and its legal representatives and assigns to the rights of my image, likeness and sound of my voice as recorded on audio or video tape. I understand that my image may be copied, distributed, edited, or published and waive the right to approve or inspect the finished photograph, video, advertising, copy, or printed matter that may be used, where in my likeness appears.

I understand that this material may be used in diverse educational settings within an unrestricted geographic area.

I understand that I will NOT be paid for these photographs and/or video footage. I am participating as a volunteer.

I release E-telmed, employees, and agents from any and all claims of harm and liability as a result of any alteration, blurring, distortion or use in composite form, either intentionally or otherwise, which may occur from distributing, making, showing or using these photographs/video.

By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby.