Consent for Use and Disclosure of Content by the Medical College of Wisconsin

I understand that by signing and submitting this consent form, I am entering into a legally binding contract permitting the Medical College of Wisconsin (MCW), its agents or employees (or any bona fide news media personnel), to use the Content provided in accordance with this consent. I understand I am consenting to certain releases and waivers described in this consent.

Consent to Use of Content.
I permit MCW to use Content including photographs, pictures, videos, motion pictures, images, audio, audiovisual works, music, data, text, literary works, musical works, dramatic works, documents, illustrations, artworks, graphical works, sound recordings, designs, drawings, animation, graphics, writings or similar content (“Content”) which I have provided to MCW, or which MCW has created, for use in print and digital publications; intranet and other internal communications; press releases; and social media, mobile and web-based platforms (“Platforms”).

I permit MCW to use the Content for educational, advertising, fundraising, marketing and promotional purposes and to publicize Content via its Platforms.

I permit MCW to add its own hashtags or comments to the Content or to incorporate any third-party materials, technology or software to the Content.

I permit MCW to use my name (or the name of my dependent, as applicable) in connection with any Content.

I waive any right to inspect or approve my depictions (or the depictions of my dependent) in the Content.

No Payment Obligation. I am providing my consent in consideration of the ability to share the Content. I understand that I will not receive and do not expect payment for MCW’s use of the Content.

Ownership and Right to Use Content.

• I retain ownership of all copyrights or other intellectual rights in the Content.
• I grant MCW a perpetual, nonexclusive, worldwide, royalty-free right and license to use, display, copy, distribute, post, repost, sublicense, perform, exhibit, transmit, broadcast, create derivatives from, publish, and reproduce the Content for the Purpose.
• I represent to MCW that: (a) I have the legal right to grant to MCW the license to use my Content, (2) I am not violating any other person’s ownership, intellectual property rights or privacy rights in the Content by permitting MCW to use the Content and (c) I am the sole owner and creator of the Content.

Release. I fully release MCW, its affiliates, and their employees, volunteers, contractors, directors, officers, attorneys, and agents (“representatives”) from any and all liability, or claims arising out of or related to MCW’s use of the Content pursuant to this consent. I acknowledge that this consent is being made solely for the benefit of MCW and without any expectation of compensation or other benefit to me. To the extent that any benefit accrues or might accrue to MCW from the use or disclosure of Content, I hereby and forever waive any interest in or claim to such benefits.

Priority of Agreement. In the event of a conflict between the provisions of the HIPAA or FERPA Authorization and this Consent, the provisions of the HIPAA or FERPA Authorization will control.

Social Media Site Terms of Use.

I understand that each of the Platforms has its own terms of use that relate to posting Content.

I understand that certain Platforms retain the right to store the Content you have provided to MCW, even if MCW removes the Content from the Platforms. You may locate those Platform terms of use at the respective Platform’s home pages.

By signing below and submitting this authorization, I confirm that I am entering into a legally binding agreement with the Medical College of Wisconsin. We appreciate your willingness to share your content with us.