Program Participant Consent/Release:
Use of Art Therapy Work Products &
Engage in Art Therapy & Confidentiality
CONFIDENTIALITY
I hereby acknowledge that for the duration of the Twistshop program I will be sharing, and be a witness to the sharing of personal information of participants. I will respect the privacy and confidentiality of the participants within the workshop/webinar and not disclose any individual’s private information. I understand that Twist Out Cancer will not reveal personal contact information or display my artwork for reasons outside of promoting/sharing the mission of Twist Out Cancer.
CONSENT FOR USE AND DISCLOSURE OF IMAGES/VOICE/RECORDINGS
For good and valuable consideration, receipt of which is hereby acknowledged, I authorize Twist Out Cancer and its third party contractors permission to videotape or photograph me and/or my artwork (the Materials). I further give Twist Out Cancer permission to interview me and/or photograph artwork created by me in a professional setting for the purpose of future marketing or education on the therapeutic use of art therapy. I understand that my full legal name will not be revealed in any presentation or display of my artwork without my permission. I understand that for purposes of this consent, the terms “image,” “voice” and “photograph” encompass still photographs, digital images, audiotapes and any other method to reproduce or edit my likeness, image or voice, now known or hereafter developed.
Twist Out Cancer shall be the owner of the results and proceeds of such taping, photography, and recording with the right, throughout the world, an unlimited number of times in perpetuity, to copyright, to use, to publish, and to license others to use in any manner, including on the Internet, all or any portion thereof or a reproduction thereof, free of any payment, royalty, or other compensation of any kind to me. I expressly understand and agree that the Materials and all results and proceeds derived therefrom, shall be the sole and absolute property of Twist Out Cancer for any and all purposes whatsoever in perpetuity, free and clear of all claims whatsoever by me and/or on my behalf. I further represent that any statements made by me during my appearance or in the Materials are true to the best of my knowledge and that neither they nor my appearance will violate or infringe upon the rights of any third party. I hereby represent and warrant that I have not given any other person, entity or firm the exclusive right to use by name, likeness, voice or photograph, and that by signing this document I am not in breach of any other agreement to which I am a party.
I hereby waive any right of inspection or approval of the Materials and my appearance in such Materials and the uses to which such Materials may be put. I agree that the Materials may be edited in the sole discretion of Twist Out Cancer and that Twist Out Cancer is under no obligation to use the Materials. I acknowledge that Twist Out Cancer will rely on this permission potentially at substantial cost to Twist Out Cancer and I hereby agree not to assert any claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder. I release the contracted program facilitator, and Twist Out Cancer from any and all responsibility and liability which may result from participation.
