Street Address?

When are you available to volunteer?
 Monday Morning
 Monday Afternoon
 Monday Evening
 Tuesday Morning
 Tuesday Afternoon
 Tuesday Evening
 Wednesday Morning
 Wednesday Afternoon
 Wednesday Evening
 Thursday Morning
 Thursday Afternoon
 Thursday Evening
 Friday Morning
 Friday Afternoon
 Saturday Morning

If you are volunteering with a group, please indicate the number of members who would be joining you

Photo Release
I, the Releasing Party, hereby irrevocably grant permission to Healthier Moms and Babies, and its respective agents, licensees, successors, and assigns, subject to the terms hereof, in perpetuity, the worldwide, non-exclusive, royalty-free, fully paid up license to photograph or otherwise record me and/or my minor child and to edit, reproduce, display, exhibit, publish, broadcast, distribute, and otherwise use, and permit others to use, my and/or my minor child’s name, image, nickname, initials, symbols, likeness, signature, photograph, voice, statements, testimonials, biographical material, and any and all attributes of my and/or my minor child’s personality and appearance (collectively, my “Likeness”), in whole or in part, alone or with other materials, in any and all manner and media now known or hereafter devised, including without limitation on websites owned by or affiliated with Healthier Moms and Babies, in social media channels, brochures, newsletters, newspapers, and magazines, and in other public relations or promotional materials (collectively, the “Materials”).
I acknowledge that Healthier Moms and Babies has no obligation to use any Materials or my Likeness. I agree that no further approval is required for Healthier Moms and Babies to use any Materials or my Likeness and that Healthier Moms and Babies will not be liable for any distortion or illusionary effect resulting from the exhibition, publication, or broadcast of any Materials or my Likeness. I acknowledge that all right, title, and interest in and to the Materials, including without limitation all copyrights and publicity rights, shall be the sole and exclusive property of Healthier Moms and Babies. I acknowledge and agree that no further payment or consideration will be due for Healthier Moms and Babies’ use of the Materials or my Likeness as authorized by this Consent and Release.
With regard to Healthier Moms and Babies’ exploitation of the rights granted hereunder (including, without limitation, the use of the Materials or my Likeness in any advertising, promotional, or marketing materials), I, on behalf of myself, and my minor child, if applicable, and our respective heirs, executors, administrators, and assigns, hereby irrevocably release, discharge, and waive all claims, demands, losses, and liabilities of any nature against the Healthier Moms and Babies that I, or my minor child, if applicable, or our respective heirs, executors, administrators, and assigns had, now have, or hereafter may have, including, but not limited to, claims in the nature of copyright infringement, defamation, disparagement, slander, false light, violation of the right of privacy or publicity, or the like.
This Consent and Release shall be governed by and interpreted in all respects in accordance with the substantive laws of the state of Indiana, without regard to its choice of law or conflicts of law principles. I irrevocably agree that any disputes directly or indirectly arising out of or relating to this Consent and Release shall be resolved exclusively in the state or federal courts located in Allen County, Indiana. I hereby irrevocably consent to such venue and to the exclusive jurisdiction of any such court over any such dispute.
If any provision of this Consent and Release is determined to be invalid by a court of competent jurisdiction, such determination shall in no way affect the validity or enforceability of any other provision herein. This Consent and Release sets forth the entire agreement of the parties with respect to the subject matter hereof and supersedes any and all prior or contemporaneous oral or written representations, discussions, negotiations, understandings, or agreements relating to the subject matter hereof. This Consent and Release may not be modified except by an instrument in writing signed by both parties.
I have read, understood, and voluntarily agree to be bound by this Consent and Release.

Qualifications
 Hopper Helper