This Photo, Video, and Medical Imagery Release and Consent Agreement (“Agreement”) is entered into as of the date signed below by and between the undersigned individual (“Participant”) and
Lumisque Inc., including its parents, subsidiaries, affiliates, sub-brands (including but not limited to
CO2Lift®, CO2Lift® V, and any future Lumisque brands), successors, assigns, licensees, distributors, marketing partners, and any third parties acting with Lumisque’s authorization (collectively, the “Company”).
1. Grant of Rights
Participant hereby irrevocably grants to Company the perpetual, worldwide, royalty-free, transferable, and sublicensable right to photograph, film, record, and otherwise capture Participant’s likeness, image, appearance, voice, body, and/or performance in still images, video, audio recordings, before-and-after photographs, treatment imagery, and other media (collectively, the “Content”).
Participant further grants Company the unrestricted right to use, reproduce, edit, retouch, adapt, modify, create derivative works from, publish, republish, distribute, transmit, display, perform, archive, store, and otherwise exploit the Content, in whole or in part, for any lawful purpose, in any format or medium now known or later developed, without limitation.
2. Authorized Uses
Participant expressly authorizes Company to use the Content for all internal, external, educational, clinical, and commercial purposes, including but not limited to:
Clinical education, scientific presentations, professional training, continuing education, and medical or aesthetic conferences.
Internal and external trainings, webinars, demonstrations, protocols, instructional materials, and educational decks.
Paid and organic advertising, sponsored content, social media, websites, email marketing, digital platforms, e-commerce, online marketplaces, public relations, and brand campaigns.
Brochures, sales materials, packaging inserts, point-of-sale displays, in-office materials, trade shows, and presentations.
Press materials, interviews, articles, features, documentaries, and branded or unbranded editorial content.
This authorization applies to Company-owned platforms and third-party platforms operated by or on behalf of Company.
3. Medical Context & Results Disclaimer
Participant acknowledges and agrees that:
- Before-and-after images represent individual outcomes only
- Such images do not guarantee or promise specific results
- Results may vary based on individual factors, protocols, and conditions
Participant authorizes Company to reference non-identifying treatment context, including general procedure type, treatment category, and timing of results, provided no protected health information beyond what appears in the Content is disclosed.
4. Ownership & No Compensation
Participant acknowledges that all rights, title, and interest in the Content, including all copyrights and intellectual property rights, are the exclusive property of Company.
Participant waives any right to inspect or approve the finished Content or its use and agrees that no compensation, royalty, credit, or remuneration is owed now or in the future unless expressly agreed to in writing.
5. Release of Liability
Participant fully releases and holds harmless Company and its officers, directors, employees, agents, contractors, licensees, successors, and assigns from any and all claims arising from authorized use of the Content, including claims for invasion of privacy, right of publicity, defamation, emotional distress, or misrepresentation.
Participant understands Company cannot control unauthorized third-party use once Content is published.
6. Identification & Privacy Preference
Please select one:
Participant acknowledges complete anonymity cannot be guaranteed.
7. Revocation of Consent
Consent may be revoked only in writing. Revocation applies prospectively only and does not affect Content already captured, published, distributed, archived, or incorporated into materials.
All rights granted survive revocation with respect to Content created prior to written notice.
8. EU / GDPR Notice (EU & UK Participants)
For participants located in the European Union or United Kingdom, Company processes personal data under GDPR Article 6(1)(a) (consent).
Participant acknowledges:
Personal data may be transferred and stored outside the EU/UK, including in the United States
Company will apply appropriate safeguards where required
Participant has the right to request access, correction, or restriction of personal data, subject to lawful limitations
Participant understands that once Content is incorporated into published or archival materials, erasure may not be possible.
9. Canadian Privacy Notice (PIPEDA)
For participants located in Canada, Participant consents to the collection, use, storage, and disclosure of personal information in accordance with PIPEDA and applicable provincial privacy laws.
Participant acknowledges:
- Personal information may be stored or processed outside Canada
- Content may be used for commercial and promotional purposes
- Withdrawal of consent does not affect prior lawful use
10. Representations & Warranties
Participant represents that:
- Participant is 18 years of age or older and legally competent
- If under 18, a parent or legal guardian has executed this Agreement
- Participation is voluntary
- Execution does not violate any other agreement
11. Governing Law
This Agreement shall be governed by the
laws of the State of Florida (USA), without regard to conflict-of-law principles.
12. Entire Agreement
This Agreement constitutes the
entire understanding between the parties and supersedes all prior agreements related to this subject matter.
Participant Information
IF PARTICIPANT IS UNDER 18
IMAGE UPLOAD
