By submitting this form, I confirm that I am the adult shown in the photographs I am uploading, or that I am the parent or legal guardian of the person shown, and that I have the authority to grant this release.

I grant The MED13L Foundation, a nonprofit organization, and its staff, volunteers, agents, and authorized partners permission to use, reproduce, edit, crop, adapt, publish, and distribute the photographs I submit, along with any caption or story I provide and the likeness of the person shown.

I understand these photographs may appear in Foundation materials that support awareness, education, fundraising, and research. These materials include the Foundation website, social media accounts, printed publications, newsletters, presentations, grant applications, and reports to funders and partners.

I understand that using these photographs in connection with The MED13L Foundation may identify the person shown as someone affected by MED13L syndrome or connected to the MED13L community, and that this information may become publicly visible. I consent to this use.

I understand that I will receive no payment for the use of these photographs, now or at any time in the future.

I keep ownership of my original photographs. This release grants The MED13L Foundation a nonexclusive, royalty-free, worldwide license to use them for the purposes described above.

I understand this permission stays in effect until I withdraw it. I may withdraw my permission at any time by emailing the Foundation at the address listed below. Withdrawal stops future use. It cannot recall materials that were already printed, published, or distributed before the Foundation received my request.

I release The MED13L Foundation, and its staff, volunteers, agents, and authorized partners, from any claim, demand, or liability that arises from the authorized use of these photographs, including any claim related to editing, cropping, or the setting in which the photographs appear.

I confirm that the information I have provided is accurate, and that I submit these photographs voluntarily.

Questions or withdrawal requests: social@med13l.org. The MED13L Foundation, 14 Main Street, Park Ridge, IL 60068.