Consent to Image / Video Terms and Conditions

 I hereby consent to and authorize Salt Lake Behavioral Health, UHS of Delaware, Inc., and all of their affiliates (collectively “UHS”) to use my image, voice, video submissions and/or statements in educational pieces, commercial promotions, advertisements, social media, or in any other manner at UHS’ sole discretion. I understand that my image, video submissions, voice, and/or statements may be recorded and videotapes, audio tapes, photographs, or interviews, and my consent and authorization applies to any such recording and may be used in whole or in part by UHS at its discretion. I understand and agree I have no rights to the images or materials generated by UHS or the materials I submit to them in reliance on my consent and authorization, and I give any rights I may have to prior approval of the use of my image, video submission, voice, and/or statements by UHS. I hereby release UHS and all of its respective employees, officers, directors, and agents from liability of any kind based on the use of my image, video submission, voice, and/or statement. I further waive any rights to any form of payment or compensation I may have in connection with UHS’ use of my image, voice, video submission, and/or statements. I understand that I may revoke my promotional consent and authorization at any time by informing UHS of Delaware, Inc., attention Marketing Department, in writing that I am revoking my consent and authorization. I understand that my revocation does not apply to the extent UHS has already used my recording in reliance on this authorization or if immediate revocation would cause additional expense or hardship to UHS in completing its current promotional campaigns. I have had the opportunity to read and consider the contents of this consent and authorization. My signature below indicates that I understand and agree to the terms herein.