Moonshot Consent Form

Subject hereby grants Moonshot Learning LLC (“Moonshot”) the exclusive right to use the photograph(s), quotation(s). directors’ treatment(s), contact information(s)/detail(s), sound recording(s) and/or movie clip(s) ("Material") depicting Subject and/or Child, that is/are shot/recorded/collected while the Subject and/or Child are part of any HMS MEDScience Moonshot programming, for any media, public relation or marketing use or derivative works, and for all merchandising purposes. The Material will always be used in accordance with Moonshot values. Subject acknowledges that the depiction of him/her/the Child in the Material may be duplicated and distributed in any and all manner and media throughout the world in perpetuity.

The contact information collected on the Subject will be stored for no longer than three years. All other Material will be stored in a historical archive in perpetuity.

Subject grants Moonshot the exclusive right, license and privilege to utilize the Subject's portrait, likeness, and visual representations in the Material as well as derivatives hereof in connection with the manufacture, advertising. distribution and sale of any articles or products. Subject will not receive any consideration for the rights - including rights in the nature of intellectual property rights - granted to Moonshot hereunder.

Subject hereby releases and discharges Moonshot, its employees, agents, licensees, successors and assigns from any and all claims, demands or causes of actions that it may have or may from now on for libel, defamation, invasion of privacy or right of publicity. infringement of copyright or trademark, or violation of any other right arising out of or relating to any utilization of the rights granted under this declaration.

Subject warrants and represents that Subject possesses all rights necessary for the grant of this license and will indemnify and hold Moonshot its licensees and assigns harmless from and against any and all claims. damages, liabilities, costs and expenses arising out of a breach of the foregoing warranty.

Subject agrees that Moonshot shall have the unlimited right to vary, change, alter, modify, add to and/or delete from the depiction in the Material, and to rearrange and/or transpose the depiction, and to use a portion or portions of the depiction or character together with any other literary dramatic or other material of any kind.

Subject has not committed or omitted to perform any act by which such rights could or will be encumbered, diminished or impaired; Subject further represents and warrants that no attempt shall be made from now on to encumber, diminish or impair any of the rights granted herein and that all appropriate protection of such rights will continue to be maintained by Subject.

All rights, licenses and privileges herein granted to Moonshot are irrevocable and not subject to rescission, restraint or injunction under any circumstances. Nothing herein shall be construed to obligate Moonshot Learning LLC to produce, distribute or use any of the rights granted herein. Subject does not have any approval rights to the use of the Material.

This declaration shall be construed according to the laws of the state of Massachusetts.

This declaration contains the entire understanding of the parties relating to the subject matter, and this declaration cannot be changed except by written approval from Moonshot.