Publicity and Data Use Authorization & Release Policy 

The signatories to the Publicity Release Form on the frontside of this form (“Grantors”) consent to use of their name, voice, images, videos, likeness, distinctive appearance, testimonial, statements, text, blogs, and posts (“Media”) and related health information and imaging disclosed by Grantors or derived from medical records (“Patient Data”), by OrthoPediatrics Corp., its successors, assignees, subsidiaries including Boston O&P, and affiliates, and their officers, employees, representatives, and agents (collectively referred to as “OrthoPediatrics”) for authorized promotional or educational purposes.

Grantors understand and agree that the Media and Patient Data may be edited and used in any form, content, or medium by OrthoPediatrics without further permission, including in print and electronic materials, websites, social media, and presentations, for any authorized promotional or marketing purposes and for any authorized non-profit or educational purposes.  Grantors further understand and agree that the Patient Data may be shared without further permission with clinical partners of OrthoPediatrics for research, public health, or health care operations.  

Patient Data derived from medical records will be de-identified or limited before use to the extent required by law.  Grantors waive any right to review or approve the finished content or final use to which the Media or Patient Data is applied.  Grantors further understand and agree that all such use of the Media and Patient Data and associated copyrights, trademark rights, and other intellectual property rights, worldwide, is the exclusive property of OrthoPediatrics, regardless of form, and Grantors will take no action to challenge such rights or ownership. 

Grantors, for themselves and their relatives, heirs, assignees, executors, and administrators, release all claims, now or in the future, of any nature, against OrthoPediatrics and their affiliated companies and employees related to the authorized use of the Media and Patient Data.  Grantors further agree to indemnify and hold harmless OrthoPediatrics and their affiliated companies and employees from and against all claims and liability for damages, losses, or expenses arising from the authorized use of the Media and Patient Data, including but not limited to claims related to the right of publicity or privacy.

GRANTORS HAVE READ AND UNDESTOOD THE CONTENTS HEREOF AND HAVE THE AUTHORITY TO CONSENT TO THIS AUTHORIZATION AND RELEASE. Grantors understand that consent to this Authorization and Release is voluntary, and the quality of care does not change based on its execution.