top of page


I hereby consent and authorize Scripta Insights, Inc. and their agents, contractors, and representatives (hereinafter “Scripta”) to take photographs, video, and audio of me or otherwise record my appearance, voice, or likeness, or document my name, biography, statements, signature, and words  (collectively “Content”) for use in commercial, marketing, and other promotional materials as outlined in this Consent. The information or items to be prepared and released by Scripta, using or based on the Content, are referred to hereafter as the “Materials.” I understand that the Content and the Materials may contain my name, image, likeness, biography, statements, signature, words, voice, movements and/or other identifying characteristics or data.


By agreeing to this Consent, I certify that I personally and in good faith believe in the truthfulness of all of the statements I made and opinions I expressed in the course of preparation and/or recording of the Content. If at any time I no longer believe in or endorse one or more of any such statements or opinions, I will promptly and in writing so notify Scripta in writing. 


I understand that the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations governing privacy (collectively “HIPAA”) may require that I also sign an authorization to use and disclose my protected health information (“HIPAA Authorization”). I understand that the HIPAA Authorization sets forth certain of my rights under HIPAA and that nothing herein shall be viewed as affecting such rights.


I hereby authorize Scripta to display, release, or otherwise provide the Content and the Materials to the general public worldwide, in any and all media, including, but not limited to, print materials of all kinds, publications, point-of-purchase advertising, packaging, broadcast, cable, satellite or other transmission, and the internet, for the purposes of marketing, publicity, commerce, trade, and advertising, and any other purposes stated on the HIPAA Authorization.


I hereby grant Scripta the exclusive worldwide right to use, control, reproduce, market, broadcast, display, print, publish, exhibit, edit, alter, copy, license, create derivative works of, or sell, either in whole or in part, the Content and the Materials. This may include, but is not limited to, editing, cropping, retouching and otherwise altering the Content and the Materials at the sole discretion of Scripta. I agree that all intellectual property rights associated with the above described Content and Materials are and shall remain the property of Scripta as well as any other rights, title, and interest in any and all results and proceeds associated with such use or disclosure. 


I understand and agree that Scripta has no obligation actually to use the Content or the Materials prepared under the terms of this Consent, and has no obligation to use my name or any other form of attribution in connection with any Materials that may be used. I understand I will not receive any payment or other monetary consideration in exchange for signing this Consent or for the use or disclosure of any of the above Content or Materials and that my only consideration in connection with executing this Consent is potential inclusion of the Content into the Materials. I hereby waive all rights that I may have to any claims for payment, compensation or royalties in connection with the use of the Content or Materials or any exhibition, televised event, or publication of the Content or Materials, including, but not limited to, testimonials or photographs, motion pictures, or video tapes, prepared pursuant to this Consent.


By agreeing to this Consent, I hereby fully release, indemnify and hold harmless Scripta and its officers, directors, employees and agents of any nature whatsoever, on behalf of myself, my successors or assigns, from and against any and all liabilities, claims, damages or injuries whatsoever, arising out of, having any connection with or as a result of my participation related to the Content or Materials, including but not limited to, the taking of or preparation of the Content or Materials, and their use, re-use, copying, distribution, publication, release, disclosure or display, including any liabilities arising from any invasion of privacy, whether by intrusion, misappropriation or publication of private facts, or from any negligent acts of Scripta or its officers, directors, employees or agents.


This Consent, which may be modified only in writing signed by Scripta and me, constitutes our entire agreement and supersedes any prior implied, oral or written agreements, and shall inure to the benefit of and be enforceable by Scripta, and its successors and assigns. 


I HEREBY REPRESENT AND WARRANT that I have read the above Consent and that I am fully familiar with its contents.

bottom of page