ITLLC Release Form

I understand that one of the goals of Insight Therapies LLC (ITLLC) is to collect online stories from participants that may be used in connection with the initiative. The information obtained through this release will serve as a record of participants' experiences, and may be used by Insight Therapies LLC, assigns, designees and its licensees for scholarly, educational, promotional and/or commercial purposes at the discretion of ITLLC.


I understand that ITLLC plans to retain the product of my participation (“the Product”) as part of its permanent collection and that any materials obtained through this release may also be used for exhibition, publication, presentation on the World Wide Web and successor technologies, broadcast documentaries, and for other promotional or commercial activities in any medium.

I hereby grant to ITLLC ownership of the Product and I hereby assign to ITLLC any copyright rights that I may hold in this material.


I hereby warrant that the use of this material by ITLLC or its licensees will not violate the rights of any other person or entity.

I also grant to ITLLC and its assigns, designees, and licensees the irrevocable and perpetual right to use, reproduce, distribute, reuse, transmit, display, publish and republish, my name, likeness, and comments, including, without limitation, the right to use the foregoing in any manner, in whole or in part, individually or in conjunction with other materials, in any medium and for any purpose whatsoever, including, without limitation, the exhibition, advertising and exploitation of ITLLC in any and all media or other use of ITLLC.


I understand and acknowledge that ITLLC owns the copyright and all other rights in and to ITLLC and may exclusively use ITLLC in any manner. I also understand that I will not have any right of approval or receive any compensation as a result of any use or re-use of ITLLC. I hereby waive any rights of privacy or publicity that I may have with respect to ITLLC and any use or re-use of ITLLC and release and hold ITLLC and its licensees harmless from any and all claims and demands arising out of, related to or in any way connected with ITLLC including, without limitation, any and all claims for invasion of privacy, infringement of my rights of privacy and/or publicity, defamation, and any other personal and/or property rights.


I confirm that all statements that I make will reflect my honest opinions, beliefs and/or experiences and that any representations made shall be true and accurate to the best of my knowledge.


By  submitting a story for entry, you certify that you have rights and/or permission to share any personal information contained therein, including medical information, personal image rights, and privacy rights, and agree to release and/or indemnify ITLLC against any claims arising from ITLLC subsequent use of submitted materials in conjunction with the ITLLC campaign, including without limitation claims that submitted materials violate the intellectual property rights of any third party.