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Photo Release

I, the undersigned, hereby grant the International Foundation for CDKL5 Research (IFCR) permission to use my likeness in a photograph or video in any and all of its publications, brochures, and multimedia, including website and social media entries, without payment or any other consideration. It is understood that all photographs or videos may be archived and used in the future.

I understand and agree that these materials will become the property of the IFCR and will not be returned.

I hereby irrevocably authorize the IFCR to edit, alter, copy, exhibit, publish or distribute this photo or video for purposes of publicizing the IFCR’s programs or for any other 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 or video. I hereby hold harmless and release and forever discharge the IFCR 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.

I am at least 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

IFCR Photo Release

IFCR Photo Release

Please provide the requested information in the areas below to complete the release of photos:
If the person signing is under age 18 or is unable to sign, there must be consent by a parent or guardian, as follows: I hereby certify that I am the parent or guardian of the above named, and do hereby give my consent without reservation to the foregoing on behalf of this person.
Your Full Name
Your Full Name