I hereby authorize Missouri Baptist Medical Center to use the photograph(s)/digital image(s) and related story which I have voluntarily provided. I further consent to and grant Missouri Baptist Medical Center permission to use my likeness and photograph(s)/digital reproductions of my image(s), in connection with the promotion of the MBMC Childbirth Center and related services, for subsequent publication on mobapbaby.org and social media, and all types of electronic communications media as well as hospital publications and fundraising materials for Missouri Baptist Medical Center and its departments. I certify that I have all rights needed to provide such photograph(s)/digital image(s) to Missouri Baptist Medical Center for the purposes described herein.

I understand and agree that once submitted by me these materials become and remain the property of Missouri Baptist Medical Center and will not be returned to me. I hereby hold harmless and release and forever discharge Missouri Baptist Medical Center and BJC HealthCare 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 concerning the photograph or this authorization.

I have read this release before signing below and I fully understand the contents, meaning and impact of this consent and release.