%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R ] /Count 1 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R >> >> /MediaBox [0.000 0.000 612.000 792.000] >> endobj 4 0 obj [/PDF /Text ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20210921105705+00'00') /ModDate (D:20210921105705+00'00') /Title (Report 09-2021) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Contents 7 0 R >> endobj 7 0 obj << /Length 2344 >> stream 0.267 0.267 0.267 rg BT 38.250 743.982 Td /F1 12.0 Tf [()] TJ ET BT 309.320 743.982 Td /F2 12.0 Tf [(Release)] TJ ET BT 535.750 743.982 Td /F1 12.0 Tf [()] TJ ET BT 38.250 728.022 Td /F1 12.0 Tf [()] TJ ET BT 38.250 712.062 Td /F1 12.0 Tf [()] TJ ET BT 318.998 712.062 Td /F2 12.0 Tf [(Date)] TJ ET BT 535.750 712.062 Td /F1 12.0 Tf [()] TJ ET BT 36.750 701.544 Td /F1 9.0 Tf [(1. I hereby give permission to Children's Hospice International, Inc, which is located at 1101 King Street, Alexandria, VA 22314 )] TJ ET BT 36.750 692.386 Td /F1 9.0 Tf [(\("CHI"\), and anyone else designated by CHI to use \(including without limitation to reproduce, distribute, and display\) and to adapt )] TJ ET BT 36.750 683.229 Td /F1 9.0 Tf [(artwork, stories, photographs and other material \(collectively, the "Works"\) created by _________________ or containing the )] TJ ET BT 36.750 674.072 Td /F1 9.0 Tf [(image, voice, likeness and/or name of _________________________. I give this permission for any purpose, in all media )] TJ ET BT 36.750 664.914 Td /F1 9.0 Tf [(\(including without limitation for use on CHI's website, http://www.chionline.org/, and in print\) and throughout the world forever on a )] TJ ET BT 36.750 655.756 Td /F1 9.0 Tf [(nonexclusive basis. I have not granted to anyone else rights inconsistent with the rights that I grant to CHI in this Release.)] TJ ET BT 36.750 639.849 Td /F1 9.0 Tf [(2. I am giving this permission in exchange for and recognizing all of the benefits and support that CHI provides to children and their )] TJ ET BT 36.750 630.691 Td /F1 9.0 Tf [(families.)] TJ ET BT 36.750 614.784 Td /F1 9.0 Tf [(3. This permission constitutes the entire understanding between CHI and myself with respect to the subjects discussed in this )] TJ ET BT 36.750 605.626 Td /F1 9.0 Tf [(Release, and may not be amended except by a writing signed by both CHI and myself.)] TJ ET BT 36.750 589.719 Td /F1 9.0 Tf [(I have the authority to give this permission on behalf of ______________________, a minor child.)] TJ ET BT 36.750 573.812 Td /F1 9.0 Tf [(___________________________________)] TJ ET BT 36.750 557.904 Td /F1 9.0 Tf [(Print Name of Parent/Legal Guardian)] TJ ET BT 36.750 541.996 Td /F1 9.0 Tf [(____________________________________)] TJ ET BT 36.750 523.647 Td /F1 12.0 Tf [()] TJ ET endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Helvetica-Bold /Encoding /WinAnsiEncoding >> endobj xref 0 10 0000000000 65535 f 0000000008 00000 n 0000000073 00000 n 0000000119 00000 n 0000000283 00000 n 0000000312 00000 n 0000000450 00000 n 0000000513 00000 n 0000002909 00000 n 0000003016 00000 n trailer << /Size 10 /Root 1 0 R /Info 5 0 R >> startxref 3128 %%EOF CHI Right of Publicity Release | Children's Hospice International
1800 Diagonal Road, Suite 600, Alexandria, VA 22314

CHI Right of Publicity Release

Letterhead

Release

Date

1. I hereby give permission to Children’s Hospice International, Inc, which is located at 1800 Diagonal Road, Suite 600 Alexandria, VA 22314 (“CHI”), and anyone else designated by CHI to use (including without limitation to reproduce, distribute, and display) and to adapt artwork, stories, photographs and other material (collectively, the “Works”) created by _________________ or containing the image, voice, likeness and/or name of _________________________. I give this permission for any purpose, in all media (including without limitation for use on CHI’s website, http://www.chionline.org/, and in print) and throughout the world forever on a nonexclusive basis. I have not granted to anyone else rights inconsistent with the rights that I grant to CHI in this Release.

2. I am giving this permission in exchange for and recognizing all of the benefits and support that CHI provides to children and their families.

3. This permission constitutes the entire understanding between CHI and myself with respect to the subjects discussed in this Release, and may not be amended except by a writing signed by both CHI and myself.

I have the authority to give this permission on behalf of ______________________, a minor child.

___________________________________

Print Name of Parent/Legal Guardian

____________________________________

[pdfex text=’Download’ template=’3′]

Please mail completed and signed form to:

Children’s Hospice International
1800 Diagonal Road, Suite 600
Alexandria, VA 22314
PHONE: 703.684.0330
EMAIL: INFO@CHIONLINE.ORG
WEBSITE: WWW.CHIONLINE.ORG

 

Back to Helpful Resources


Upload Right of Publicity Release Document:

Upload PDF
Contact Person:
E-mail Address: