Releasor consents to the dissemination and use of the patient’s name, likeness, and recorded voice singularly or in conjunction with other photographs and/or recording by the print, television, and radio media, for the purposes of pediatric cancer awareness and for raising funds to further the goals of Clemy's Crew, INC. (“media consent”). Releasor acknowledges that s/he has the right to revoke this media consent at any time in writing signed by Releasor. The revocation will only be effective upon receipt by Clemy's Crew, INC. .