Photo Release Form

I grant permission to Pacific Islander Health Board of Washington and Rainer Valley Birth and Health Center, and its staff, the irrevocable and unrestricted rights to reproduce the photographs and/or video images taken of me for the purpose of publication, promotion, illustration, advertising, or trade, in a respectful manner.  

I hereby release the Pacific Islander Health Board of WA (PIHB) and Rainer Valley Birth and Health Center its’ representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview, event, or guest lecture, with or without my name, for the purpose of advertising and publicity without restriction. I hereby waive my right to any compensation.