By signing below, I grant to Kentucky Fertility Institute, LLC and its affiliates and those acting for it (Kentucky Fertility Institute) the irrevocable, perpetual, unrestricted right and permission (unlimited as to the number of uses, times and territory) to display, modify, use, create derivative works based upon and publish for promotion, advertising, trade and any other purpose whatsoever, recordings, photographic images, portraits and pictures of me and my family and including minor children (my family) in which any of our names, voices and likenesses may be included, including all images and recordings made, published or displayed through any and all media now existing or later developed, including printed materials, electronic publications, brochures and Internet postings.

I acknowledge and agree that the use of my family’s recordings, photographs, portraits and pictures may reference reproductive medicine, including in vitro fertilization and other fertility services.  I understand and acknowledge that such use may give rise to the impression that my minor child was conceived using these services.  Notwithstanding the foregoing, I consent to such use.

I understand that neither I, nor anyone in my family, will have the ability to and I waive any right to examine or approve any completed product, advertising copy or printed matter containing any photographic image, portrait or picture of my minor child in which his or her name, voice and likeness may be included. I understand that my family will not receive any compensation of any kind in return for the rights granted hereunder.

On behalf of my family, I release Kentucky Fertility Institute, LLC from any claims or liability now or in the future existing relating to the rights granted herein, claims for libel or invasion of privacy and claims relating to any use, non-use or editing of the recordings, photographic images, portraits and pictures of me and my family.

I am over the age of 18 and have the right to contract in my own name and, being a parent or guardian of the below-listed minors, consent and agree to this release with respect to the below-listed minors. I have read this General Consent and Release prior to agreeing to it and fully understand it.