I irrevocably give Apex Dental Partners, its officers, directors, owners, employees, designees, agents, independent contractors, legal representatives, successors and assigns, and all persons or entities for whom or through whom it is acting (hereinafter collectively “Apex Dental Partners”), the absolute right and unrestricted permission to:

1. Record my likeness and voice on a video, audio, photographic, digital, electronic or any other medium (collectively “recordings”);

2. Take and use my name, testimonial, biographical data in connection with these recordings; and

3. Use, publish, reproduce, edit, exhibit, project, display and/or copyright the recordings whether still, single, multiple, or moving, or in which I may be included in whole or in part, in color or otherwise, through any form of media (print, digital, electronic, broadcast, publications, video tapes, CD-ROM, Internet or otherwise) at any facility, office, or elsewhere, for art, promotional, advertising, recruitment, marketing, fund raising, publicity, archival or any other lawful purpose.

I irrevocably waive any right that I may have to inspect and approve the finished recordings that may be used or to which it may be applied now and/or in the future, whether that use is known to me or unknown. I irrevocably waive any right to royalties or other compensation arising from or related to the use of the image or product. I understand that all such recordings, in whatever medium, shall forever remain the property of Apex Dental Partners.

I release and agree to hold harmless Apex Dental Partnerss of and from any liability by virtue of taking or using of the recordings or using the testimonial/biographical data, whether intentional or otherwise. I further release Apex Dental Partners from liability for any violation of any personal or proprietary right I may have in connection with such use of the recordings, including but not limited to any claims arising out of my right of privacy or right of publicity and any claims based on any distortions, optical illusions, or faulty mechanical reproductions.

I understand that I will not be compensated for any use of these recordings. I understand that this is a legal document and represent that I have read it and understand it and am signing it voluntarily.I certify that I am at least 18 years of age (or if under 18 years of age, that I am joined herein by my parent or legal guardian) and that this release is signed voluntarily, under no duress, and without expectation of compensation in any form now or in the future.

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