Skip to content



Non-Patient Release Form

Release for the Use and Disclosure of Images, Voice and/or Written Testimonials

Including Vail Health Foundation, Eagle Valley Behavioral Health, Colorado Mountain Medical, Howard Head Sports Medicine, and Shaw Cancer Center.

MM slash DD slash YYYY

I, (enter your full name)

give Vail Health and its authorized agents permission to record my testimonial, image and/or voice and grant Vail Health all rights to use these testimonials, recordings, or photographs, including those I have provided, in any format or medium for educational, promotional, advertising, or other purposes that support the mission of the hospital.

I understand that I am a volunteer and that I will not be compensated or paid for granting Vail Health the right to use my testimonials, images and/or voice.

I waive all claims I may have against Vail Health and its authorized agents relating to this release and my testimonial, images and/or voice.

If Signed by Parent/Guardian/Personal Representative:

The below signed parent or legal guardian of (enter child/disabled adult's name)

hereby consents to and gives permission to the above on behalf of such minor child or disabled adult.