Hope the Husky's Photo submission form

* 7. Terms and conditions agreement: By clicking, "I agree to the terms and conditions", I am authorizing the Department of Health to use, release and re-release the information, video, audio, photograph or other media that I upload or send as described above. I understand that this consent is voluntary. I understand that my refusal to sign will not affect the ability of the participant to obtain treatment, payment, eligibility for benefits or other services from the Department of Health.

I understand the stated purposes for the use or release of the information or other media as described above. I also understand that the information or media described above WILL BE MADE PUBLIC AND MY IDENTITY MAY BE DISCLOSED. I understand the information or media is no longer protected by federal or state privacy regulations once I have consented to its use and release. I relinquish all rights, title and interest to the information or other media as described above. I understand that I may request a copy of this signed consent.