UNC COLLABORATIVE FOR MATERNAL & INFANT HEALTH AND THE 4TH TRIMESTER PROJECT PERMISSION FORM
A copy of the consent disclaimer can be read below.
PRESENTATION, PHOTOGRAPHY, RECORDING & INFORMATION RELEASE AUTHORIZATION FORM
I authorize UNC Collaborative for Maternal and Infant Health (UNC CMIH) and the 4th Trimester Project team members to repost/reshare, take and/or release recordings, and any related information for public relations and/or marketing purposes. By agreeing to the information below, I give permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the 4th Trimester Project and UNC CMIH activities. I agree that the 4th Trimester Project and UNC CMIH will be allowed to claim partnership for the attributed pictures, etc., and may use them for any purpose consistent with The 4th Trimester Project’s mission. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I give permission for any slides, video/audio recordings, screenshots/still images, webinar documents captured during the collaboration/presentation to be disseminated. This includes the use of all information and materials collected in any published form and any media – including rebroadcasting in various formats, platforms, or creative derivates. Full credit to the original source will be given. I acknowledge that I may not receive any compensation, etc., for the use of such pictures, etc., and hereby release the 4th Trimester Project, UNC CMIH, and partners from any and all claims which arise out of or are in any way connected with such use.
CONTENT / INFLUENCER COLLABORATION INFORMATION RELEASE AUTHORIZATION FORM
I authorize UNC Collaborative for Maternal and Infant Health (UNC CMIH) and the 4th Trimester Project team members to repost/reshare, take and/or release content created by myself, my partners, and/or the 4th Trimester Project team. I understand my blog posts, photos, and the content will link/redirect to my own online properties, including my website and/or social media channels. By agreeing to the information below, I give permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any content created by myself, my partners, and/or the 4th Trimester Project team. I agree that the 4th Trimester Project team may use the agreed-upon content for public relations and/or marketing purposes. I agree that the 4th Trimester Project and UNC CMIH will be allowed to claim my content as ‘a contribution from a collaborator’ on the attributed content, and may use them for any purpose consistent with the 4th Trimester Project’s mission. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I may not receive any compensation for the use of such content, as agreed upon by the teams. I release the 4th Trimester Project, UNC CMIH, and partners from any and all claims that arise out of or are in any way connected with such use.
Disclaimer and Conflict of Interest Statement: The 4th Trimester Project™ adheres to and promotes the International Code of Marketing of Breast-milk Substitutes (also known as the WHO Code). We intend to only partner with individuals and organizations who adhere to the Code because we lead with our values. However, the internet is a big place and we may be unaware of concerns with content or affiliations, so please notify us if you believe review is warranted. I understand it is my responsibility to publicly share my collaboration and adhere to social media policies about disclosing paid partnerships. Please review the Disclaimer page on our site to understand more about the content we review and approve for the site.
I have read, understand, and agree to the information in this Authorization form.
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For questions or concerns, please email Suzanne Woodward (SuzanneW@med.unc.edu), Communications Manager, UNC Collaborative for Maternal and Infant Health.
