The undersigned agrees that his/her image(s) will be used by the listed Doctor/Dentist/Orthodontist/Surgeon for viewing, posting, displaying in-store/office, online and via any other medium available to the listed Doctor/Dentist/Orthodontist/Surgeon. The image(s) selected could appear online for the said Doctor/Dentist/Orthodontist/Surgeon, or glamourshots.com at the sole discretion of Glamour Shots® Licensing, Inc. (“GLAMOUR SHOTS® LICENSING”) and the listed Doctor/Dentist/Orthodontist/Surgeon. Images could be identified by the following attributes: first name and location including city and state. The undersigned acknowledges that all data will be collected by the franchisee that operates the store, along with the listed Doctor/Dentist/Orthodontist/Surgeon in which the undersigned agrees to hold GLAMOUR SHOTS® LICENSING and the listed Doctor/Dentist/Orthodontist/Surgeon harmless from any liability with respect to any data collected or the accuracy or inaccuracy of such information. GLAMOUR SHOTS® LICENSING and the listed Doctor/Dentist/Orthodontist/Surgeon will retain or destroy the images, at GLAMOUR SHOTS® LICENSING’s and the listed Doctor/Dentist/Orthodontist/Surgeon’s sole discretion, and may use them, without further notice, consent or payment, in commercial or promotional materials. By signing the Customer Consent & Release, the customer grants GLAMOUR SHOTS® LICENSING, its affiliates and franchisees, and the listed Doctor/Dentist/Orthodontist/Surgeon, a worldwide, royalty-free, non-exclusive license to use their name, likeness, biographical material and voice, as well as pictures and images of themselves, including computer-generated drawings and images of themselves special elements thereof in any production, promotion or marketing of GLAMOUR SHOTS® LICENSING, its affiliates and franchisees, and the listed Doctor/Dentist/Orthodontist/Surgeon’s practice. All pictures, videotapes, negatives and other images or likenesses of themselves produced now or in the future by or at the request of GLAMOUR SHOTS® LICENSING and the listed Doctor/Dentist/Orthodontist/Surgeon shall be the exclusive property of GLAMOUR SHOTS® LICENSING.
The undersigned releases and discharges, on behalf of himself or herself, GLAMOUR SHOTS® LICENSING, its agents, representatives, successors, affiliates and franchisees and the listed Doctor/Dentist/Orthodontist/Surgeon, from any and all claims, causes of action or liability, whether known or unknown that arise or result from this agreement. The undersigned also agrees, on behalf of himself or herself to release, indemnify and hold harmless GLAMOUR SHOTS® LICENSING, its agents, employees, representatives, successors, affiliates and franchisees, and the listed Doctor/Dentist/Orthodontist/Surgeon from any claims for damages, liability, injury, expense, or loss arising out of their participation in this agreement. This agreement shall be binding upon and shall inure to the benefit of the undersigned and their heirs, legal representatives and assigns.
PRIVACY NOTICE: ENTRANT HAS READ AND UNDERSTANDS GLAMOUR SHOTS® LICENSING’S PRIVACY POLICIES, WHICH ARE LOCATED ATglamourshots.com. CUSTOMER CONSENTS TO GLAMOUR SHOTS® LICENSING’S AND THE LISTED DOCTOR/DENTIST/ORTHODONTIST/SURGEON’S PRIVACY POLICIES AND THE COLLECTION OF THE INFORMATION CONTEMPLATED BY THIS CONSENT AND RELEASE FORM.