Valley Medical Center | Share a Photo

Share a Photo

Got a photo or image you'd like to share?

Please complete the consent form below, upload your image and click the Submit button.

Permission to Reproduce Copyright Materials

I, the undersigned, hereby expressly warrant that I, my minor child, or a person over which I may have legal guardianship, owns the copyright in the accompanying image or artwork (a.k.a. "materials") depicting:

Content Description:*

and hereby assign to Public Hospital District No. 1 of King County (a.k.a. "Valley Medical Center") the right to use the aforementioned materials in any reasonable manner for educational publications, advertising, print and electronic promotions and Web site announcements or any other promotional activities, including birth announcements in local newspapers (a.k.a. "promotional materials"). I further agree that Valley Medical Center, its Trustees, officers, employees, faculty and agents will not be responsible for any claims arising in any way out of the use of such materials. I understand that I will not have an opportunity to inspect and approve such promotional materials prior to their use.

Purpose: Valley Medical Center online promotion

First Name:*

Last Name:*

Address1:*

Address2:

City:*

State:*

Zip Code:*

Email Address:*

Phone:

*If you have legal guardianship over the owner of the aforementioned copyright materials, please indicate:

Under-aged person's name:

Your relationship or authority to consent on their behalf:

Are there any Photo Albums on Valley Medical Center's Facebook Page where you would suggest posting your photo? (Please select one)

Fan Album
Birth Center Album
Joint Center or Joint Reunion Album
GoldenCare Album
Breast Cancer Survivor Album
Other:

Upload Photo or Artwork:*

(Please check if you agree) By selecting the Submit button, I agree to the afore mentioned terms and warrant that the information provided here is true and accurate.*

First Name:*
Last Name:*
Address1:*
Address2:
City:*
State:*
Zip Code:*
Email Address:*
Phone:

Under-aged person's name:
Your relationship or authority to consent on their behalf: