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Consent & Release for Story and Photos to be used on Flight For Life's Patient Sharing Blog

• Full Name
• I grant my permission for my (or my child's/ward's) story and photo(s) to be used on the FLIGHT FOR LIFE (FFL) Patient Sharing Blog. I understand that the blog is public and this will include having links to my story on FFL's social media pages (Facebook and Twitter) accounts. I understand that editing of my story or photo(s) may be required and a revised copy of the story and/or photo(s) will be sent to me for my approval prior to being posted online.
• If I indicate that I (or my child/ward) need(s) help telling my (their) story, I consent to being photographed and/or interviewed by FFL staff, contract vendors, freelance writers or representatives of the news media.
• I give permission to include my (or my child's/ward's) full name in my story to be posted on the Patient Sharing Blog and social media.
• I DO NOT give permission for my (or my child's/ward's) full name to be included in the story to be posted on the Patient Sharing Blog and social media
• I give permission to use my (or my child's/ward's) first name ONLY on the Patient Sharing Blog and social media.
• I DO NOT give permission to use my (or my child's/ward's) first name ONLY on the Patient Sharing Blog and social media.

• I hereby release from any and all liability, Milwaukee Regional Medical Center / Flight For Life, it's personel and any other persons with Flight For Life authorization whoa re participating in a photography session and/or conducting interviews for Flight For Life purposes.

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