ATI Foundation Beneficiary Waiver & Release Form

I hereby grant to the ATI Foundation and ATI Physical Therapy the unrestricted right and permission to copyright and publish photographic/video pictures of me or in which I may be included, in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith, including my name or any statements that I have written in the form of a testimonial. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. 

I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connections therewith or the use to which it may be applied. I hereby release, discharge and agree to save harmless the Photographer/Videogrpaher, ATI Foundation, ATI Physical Therapy from any liability that may occur or to be produced in the taking of said picture use of my name or printing of my statement in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy. 

I have read the above authorization, release and agreement, prior to its execution, and I am fully familiar with the contents thereof. This release shall be binding upon me (beneficiary) and, or, parent/legal guardian, heirs, legal representatives and assigns.