BayCare Media Relations and Advertising Authorization

I hereby authorize BayCare Health System or any of its affiliated entities (collectively, “BayCare”) to use my social media post, online review, statement, photograph, video, audio recording, and/or any other form of electronic transmission, in whole or in part, for any internal or external purpose in any written or electronic format (collectively, the “Content”).  I acknowledge and agree that such use may include my name, likeness, or another descriptor that could be used to identify me, and I understand that by signing this authorization, the released Content will no longer be protected by Federal privacy regulations.  I hereby release and hold harmless BayCare, its employees, personnel, agents, and medical staff, the photographer or video photographer, and/or representatives of the news media from any or all liability, royalties, or cognizable claims that may be associated with the taking, reproduction, and/or use of such Content for any purpose and/or any media.  

This authorization shall become effective on the date signed below and shall continue in effect for a period of six (6) years.  I understand that I have the right to rescind this authorization before the Content is released, or to revoke my authorization at any time with respect to future releases of the Content, by providing written notice to BayCare.  Upon revocation or expiration of this authorization, I acknowledge and agree that any Content that has already been released shall remain in production and shall not be removed from any campaign or materials.

By signing this authorization, I acknowledge and agree that I am the individual who produced the Content and/or is depicted in the Content.  In addition, I acknowledge and agree that I am voluntarily signing this authorization and that signing or not signing this authorization will in no way impact any care, treatment, procedure, or service provided by BayCare or the status of my account or billing with BayCare.

I agree, and it is my intent, that my electronic signature/initials are the legally binding equivalent of a traditional handwritten signature/initials, and certify my acknowledgement and agreement to be bound by the terms and documents accompanying my electronic signature/initials.