Share Your Story Consent and Release

I hereby authorize Hospice of Southern Kentucky, Inc., and its licensees, successors and assigns (collectively Hospice of Southern Kentucky, Inc.) to republish the material  I am submitting to the Story Bank (Share Your Story) and also to interview, photograph, film, and/or audiotape me, and to use the Story Bank Submission and any photographs, video, audio and interview information (hereafter, collectively “Materials”) in any of its materials, including but  not limited to publications, presentations, Web sites, social media, advertising, which Hospice of Southern Kentucky, Inc. determines advances its goals.


I also authorize Hospice of Southern Kentucky, Inc. to provide the Materials to other organizations, federal or state officials, media organizations and any other individual or organization which Hospice of Southern Kentucky, Inc. believes is acting to advance its goals.


If Hospice of Southern Kentucky, Inc. wishes that I participate in an event or a one on one interview, Hospice of Southern Kentucky, Inc. may contact me for permission and scheduling but I am under no obligation to participate in such opportunity.   


I further understand and agree that I have no rights in the Materials, and that these Materials may be edited, used, published, distributed, republished and/or licensed by Hospice of Southern Kentucky, Inc., now or at any time in the future, for the purposes set forth in above. I waive all right to inspect or approve the use of the Materials, now or in the future.


I understand and agree that I will receive no monetary compensation for my participation or for the use of these Materials.


I release and discharge any and all actions or claims which I, my family members, or my heirs may have against the Hospice of Southern Kentucky, Inc., its officers, Trustees, employees, contractors and/or agents, and any other third party contracting with Hospice of Southern Kentucky, Inc., arising for any reason whatsoever from any use, publication, distribution, or republication of these Materials in accordance with this Consent and Release at any time now or in the future. I agree to defend, indemnify, and hold harmless Hospice of Southern Kentucky, Inc., and its employees, directors, officers, contractors, professional advisors, assignees and agents, from and against any and all claims, demands, expenses, losses or liabilities including, without limitation, reasonable attorney’s fees arising out of or in connection with any breach, or alleged breach, of the terms of this Agreement.


I am above 18 years of age and understand and agree to the terms set forth above for myself or a minor on whose behalf I am submitting.


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