By submitting your story you give Driscoll Children's Hospital or its representatives the right to publish the story on the www.driscollchildrens.org website along with any photographs submitted with the story. All submissions will be verified by phone before publishing.
The patients name, photo and any protected health information that you provide with your story could be used. All submissions may be edited for style, content or length. You warrant and agree that by submitting this story and/or photos that you are the sole owner/author of the materials, none of which are copyrighted.
The information collected pursuant to this Authorization becomes the property of Driscoll Children's Hospital and its representatives and may be used without further notice to you. You agree to release to Driscoll Children's Hospital any right, title or interest in the information obtained and produced.
This Authorization is given without promise of compensation. Driscoll Children's Hospital will not condition treatment on the execution of this Authorization.
You may revoke your authorization to use your or your child's information at any time, except to the extent that action has already been taken in reliance on this authorization, by delivering a copy of your revocation to Driscoll Children's Hospital Marketing Department.
By submitting this Authorization you agree to release, discharge and hold harmless Driscoll Children's Hospital and its affiliates, subsidiaries, directors, officers, employees and agents from any and all claims, actions and demands of any nature arising out of or in connection with the information covered by this Authorization.
You acknowledge that you are the patient (age 18 or over) or the legal representative of the patient (if a minor).
By selecting the "I Agree" button below, you agree to be bound by the terms of this Authorization as set forth above. (required)