Add Your Hero’s Story

Name *

First Name

Last Name

Hero's Name

First Name

Last Name

Would you like to add a picture of your hero?

Yes

No

Photo Release

I hereby grant the Holly's Heart Foundation permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the Holly's Heart Foundation and will not be returned. I hereby irrevocably authorize the Holly's Heart Foundation to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Holly's Heart Foundation from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

BY CHECKING THIS BOX, I AFFIRM THAT I HAVE READ, UNDERSTAND, AND AGREE TO THE ABOVE PHOTO RELEASE ABOVE AND THAT I AM AT LEAST 18 YEARS OF AGE.