Photo/Video Release Form

I hereby authorize Sierra Orthopedic Laboratory, Inc. to publish the photographs taken of me, and my name, for use in its printed publications and website. I acknowledge that since my participation in publications and websites produced by Sierra Orthopedic Laboratory, Inc. is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by Sierra Orthopedic Laboratory, Inc. confers upon me no rights of ownership whatsoever. I release Sierra Orthopedic Laboratory, Inc., its contractors and its employees from liability for any claims by me or any third party in connection with my participation.