CONSENT, WAIVER AND RELEASE

I grant to Midwest Anxiety, LLC and its employees, officers, agents and assigns (hereinafter referred to as “Midwest”), the right to use, reproduce, adopt, distribute, and publish photographs, video, audio or related content (“Content”) taken by Midwest that are the subject of this agreement for the sole purpose of advertising and promoting Midwest through testimonial video blogs and other methods.

I understand and agree that the Content(s) may be used in whole or in part, at any time, in composite or distorted form, in color or otherwise and may be published through any medium including, but not limited to, printed medium, video and/or on the internet.

I waive any right to inspect or approve any finished product, advertising or other copy that that uses the Content.

I agree to indemnify Midwest from and against any claims, losses, judgments, settlements, expenses and reasonable legal fees, incurred by Midwest by reason of any claim, including but not limited to claims of invasion of privacy or trespass created in the taking or publication of the Content(s).  I also agree to indemnify Midwest for any such amounts arising from my breach of any covenant, representation, or warranty of this agreement.

I understand that the terms herein are contractual and not a mere recital, that this instrument is legally binding, and that I have voluntarily signed this document.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS CONSENT, WAIVER AND RELEASE BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.

Date *
Date
Name *
Name
Which social media platform do you want us to tag you in the video?
What is your handle? We will tag you in the video at this handle.