Planned Parenthood® Permission and Release Form (“Release”) – “Share Your Story”
Thank you for agreeing to share your story about what Planned Parenthood means to you. Planned Parenthood may use your personal story publicly in a variety of projects. Please read and sign the permission and release form below, which explains how Planned Parenthood may use the information you provide to us.
For good and valuable consideration, receipt of which I, ______________________, hereby acknowledge:
- I grant to Planned Parenthood Federation of America, Inc. and all other Planned Parenthood organizations (collectively, “Planned Parenthood”) and their authorized representatives the right and permission to create photos, video, film, audio, other recordings, transcriptions, and printed and digital materials (collectively, the “Authorized Recordings”) of me that may include my voice, image, likeness, first and last name, signature, actions, age, city and state, biographical information and statements (collectively, “Likeness and Story”). If I have shared with Planned Parenthood any personal materials such as photographs, this permission extends to such materials. I understand that Planned Parenthood may use my first and last name, age, city and state when telling my story.
- I understand that I am not the owner of the Authorized Recordings. I hereby grant to Planned Parenthood, and its licensees, successors and assigns (collectively, the “Licensees”) an unconditional, irrevocable, royalty-free right and license to publish, reproduce, distribute, edit, display and otherwise use and exploit my Likeness and Story, in whole or in part, in any manner, in and in connection with the Authorized Recordings and derivative works thereof, together with any other material, edited or altered as the Licensees see fit, in perpetuity, in any media (now known or hereafter invented), throughout the world, in any language, and for any purposes whatsoever, including, without limitation, for advertising, promotion and trade purposes, all as the Licensees shall determine in their sole discretion. I grant the Licensees the right, without notice to me, to transfer, assign or sublicense their rights under this Release to any third parties who may exercise the same rights as the Licensees are authorized to do pursuant to this Release.
- Without limiting the generality of the foregoing, but solely for the purpose of providing examples, Licensees shall have the right to:
- use my Likeness and Story (or a quote there from) in a social media graphic
- broadcast video and audio podcasts containing my Likeness and Story on Planned Parenthood websites and other social media websites (such as YouTube.com), on TV or radio, or on a third party media outlet’s website
- put a reporter in touch with me to be interviewed for a story
- incorporate my Likeness and Story into an op-ed that Planned Parenthood pitches to external media sources for publication or into a speech that a Planned Parenthood representative may deliver
- use my Likeness and Story in a billboard or digital ad
- use my Likeness and Story in a variety of printed and digital collateral materials, such as brochures, annual reports, mailings, email, etc.
- use my Likeness and Story in a variety of other fundraising, advocacy, educational, informational or media outreach projects.
- I understand that I will not be able to review or approve the use of my Likeness and Story, and that Planned Parenthood may in its discretion shorten or edit my Likeness and Story. I shall have no claim to compensation or any other claim (including but not limited to claims of defamation, invasion of privacy, violation of the right of publicity, or copyright or trademark infringement) arising out of the use, alteration, distortion, illusionary effect, fictionalization, or use in composite form of my Likeness and Story.
- I grant this Release without any expectation of monetary or other compensation now or in the future, and only for the intangible consideration of being able to support a mission I believe in. I understand that the Licensees are under no obligation to exercise any of the rights granted herein.
- I warrant and represent that this Release does not in any way conflict with any existing commitment on my part.
- I have read this Release prior to signing it, understand its contents, and am authorized to grant the permissions set forth herein.
- I have read and agree to the Share Your Story terms.