Consent for Publishing Photographs and/or Recordings

1. I, the undersigned, a participant in the production and videotaping (or other recording) at Hospital for Special Surgery (or the parent, legal guardian, or person otherwise authorized to consent of such participation), hereby consent to the taking of any and all still photographs, motion pictures, television and/or video tapes, voice recording, and /or other recordings ("Recordings") of my/his/her person at Hospital for Special Surgery (the "Hospital") during the course of my/his/her participation in (the "Event") agree to the use of the Recordings as follows:

For any educational, training, contribution solicitation, marketing, promotional or other purpose, in any medium whatsoever, by the Hospital and/or by any person or persons the Hospital may name: and /or for any broadcast or other public viewing. Such Recording may be used as described above, in full or edited form, and may be incorporated into other recording or formats and may be copied for multiple distributions and/or broadcast.

2. I agree that I will receive no compensation or other remuneration for the taking, production, use, broadcast, and/or distribution of such Recordings or for my participation in any manner in such Event, and I specifically release the Hospital and all others from any liability or other obligation arising from the taking, production, use, broadcast, and/or distribution of such Recordings and from my participations in the Event.

3. I understand that I have the right to withdraw from participating in the Recording at any time during the Event and that I have the right to revoke this consent at any time to the extent that the Hospital and/or its designee have not relied upon it, or has not submitted the Recording for use in external media.