Brain Balance Media Waiver & Release

I hereby grant to BB Franchising, LLC, its parent, subsidiary and affiliated companies, agents, licensees and designees (collectively, “Brain Balance”), including their successors and assigns, the absolute, royalty-free, irrevocable, worldwide, right and permission, with respect to any testimonial or statements (written or oral), illustrations, photographs, film, video or other images, or sound recordings (“Materials”) taken by Brain Balance or taken by me and identified as “subject to Media Release” in writing:

(a) To use, re-use, publish, re-publish, copy, modify, adapt, display and create derivative works in the same in whole or in part, individually or in conjunction with other photographs, images, recordings, statements or testimonials in any medium including but not limited to social media, print, and on the Internet, and for any purpose whatsoever, including, without limitation in advertising, marketing, publications, electronic distribution, and the Internet and for any other business or commercial purpose; and
(b) To use my likeness, voice, image and/or name in connection therewith if Brain Balance so chooses, and, if one or more children are listed below, to use their likenesses, voices, images and/or names in connection therewith if Brain Balance so chooses; and
(c) To copyright the same in the name of Brain Balance, or any other name that Brain Balance may choose.


I understand that I am to receive no compensation for the permitted use of any Materials or of the name, likeness, voice, or image of me or any of my children if listed below. I hereby release and discharge Brain Balance, its employees, licensees, successors, assigns and any designee (including any agency, client, broadcaster, periodical or other publication) from any and all claims and demands arising out of or in connection with the use of such Materials, including but not limited to any claims for defamation, violation of any moral or artist rights, invasion of privacy, right of publicity, emotional distress or any similar right. Furthermore, I represent and warrant that any testimonial or statement given is original and does not infringe upon copyright or proprietary rights of another person or entity.

I hereby waive any and all rights I may have in and to such photographs, film, video or other images, sound recordings, or testimonial and assign all such rights I may have to Brain Balance and agree that I shall take no action to challenge or object to the validity of Brain Balance’s sole and exclusive ownership rights in same.

This document represents the entire agreement between Brain Balance and me with respect to this subject matter. This agreement and all actions related to it shall be governed by the laws of the State of Illinois.

I certify that I am 18 years old or older. If one or more children are listed below, I certify that I am the parent or legal guardian of those children and have the authority to execute this release on his, her or their behalf. I have read and fully understand this agreement and sign the same of my own free act.

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