Raven EMS Education Program Manual
Photo and Video Release Form

Name:

I give permission to Raven Medical, Inc or any authorized agency, television or newspaper source to take photos or videos of me. I also give permission to have those photos and/or videos used by Raven in an appropriate manner for the promotion of Raven. I release all rights to the photos and videos and the publications and media in which they are published or aired for Raven.

I hereby perpetually authorize Raven Medical, Inc. to take, use, re-use, publish, and republish photos, videos, or audio recordings in which I appear or may be heard in whole or in part, individually, or in conjunction with other photographs, in any medium, for publicity, media, or marketing purposes, including, without limitation, for purposes of illustration, promotion, advertising, or trade. I hereby release Raven from any and all claims and demands arising out of or in connection with the creation and use of such photos, videos, or audio recordings. This authorization shall inure to the benefit of the legal representatives, licenses, heirs, and assigns of myself and Raven Medical, Inc.

Signature:


Change Log (5.93.000.PVRF)

DateAuthorDescription of ChangeCitations
2024-05-17Becker, T.Theron Jack BeckerMoved this form from appendix to student manual.
2024-05-31Becker, T.Theron Jack BeckerAdded content.(Becker, 2023)Becker, T. (2023). CMH education manual. OzarksEMS. https://ozarksems.com/edman.php
2024-08-01Becker, T.Theron Jack BeckerEach form previously had dedicated sub-section numbers, but they were removed for brevity and as none of the other forms are specifically numbered. 5.93.400 was the Photo Rease
2024-12-13Becker, T.Theron Jack BeckerCreated this form.
2025-01-08Becker, T.Theron Jack BeckerMoved online from Adobe InDesign document.



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