Marketing Release Form

1. Consent and Grant of Rights

I hereby grant Bristol Hospice, its affiliates, representatives, employees, and authorized agents the perpetual,
worldwide right and permission to record, photograph, film, and/or capture my image, voice, and likeness
(collectively, “Media”) in any format. I authorize Bristol Hospice to use, publish, and distribute these Media for any
lawful business purpose, including but not limited to marketing, advertising, social media, promotional, and public
relations activities, in any form or medium now known or later developed.

2. Ownership and Use

I understand that all Media created by or for Bristol Hospice are the exclusive property of the company. I waive any
right to inspect or approve the finished product or any accompanying text or captions before publication.

3. No Compensation

I agree that no compensation, royalty, or additional consideration will be provided for the use of my image,
likeness, or voice in the Media.

4. Release from Liability

I release and hold harmless Bristol Hospice, its officers, employees, agents, contractors, and assigns from any and
all claims, demands, and causes of action that may arise from the use of the Media, including but not limited to
claims for defamation, invasion of privacy, or misappropriation.

5. HIPAA Media Release

I authorize Bristol Hospice to use photos or videos of me that may include health information for educational,
promotional, or marketing purposes.

This consent is granted in perpetuity and applies to all uses worldwide. I understand this media may be shared
publicly and that I can revoke this consent in writing at any time. If consent is revoked after media has been
published or distributed, Bristol Hospice will cease using it in future materials but cannot retract or control prior
releases.