hereby expressly grant to Asbury Communities, Inc., and its affiliates, subsidiaries, employees, agents and assigns (collectively “Asbury”), the right to photograph me and use my picture, silhouette, and other form of reproduction of the physical likeness of me, and any text (including specific protected health information limited to the following: that I work at Asbury Place of Kingsport and we are celebrating Nurses Week, birthdays, etc.) that has been written about me in connection with the exhibition in the advertising, publicizing of any such photograph or text, including the use of such on the Asbury Internet web sites.
I agree not to look to Asbury for any payment of any kind with the respect to the making of or any use of the aforesaid photographs, images, or text without limitation. I agree to hold Asbury harmless with respect thereto. This release shall be binding upon my agents, representatives, heirs, assignees, and estate.
I hereby represent to Asbury that I am over eighteen (18) years of age.
I certify and represent that I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have hereunto set my hand this