Wall of Remembrance Photo Submission

Wall of Rememberance Details

Thank you for your contribution to our Wall of Remembrance project! The Axis Health System team aims to provide psychoeducation, harm reduction, and life saving resources to support opioid use disorder and the prevention of overdose deaths in our community. One way we do this is by presenting and providing resources via our booths at various community events through the year.


We are collecting photos for those who have been lost to opioid overdoses in order to create a Wall of Remembrance. This wall will be presented at all substance use specific events where an Axis Health System booth is present in the La Plata County area from August 2024 to June 2025.

Photo & Video Consent & Release

Effective as the date shown below, permission is hereby given to Axis Health System by the undersigned to use the photograph and all other information submitted with this form (collectively the "photo") for the purposes set forth herein. The undersigned represents and warrants that they have full authority to sign this "consent and release" on behalf of themselves and the person whose photo is being submitted.


For a valuable consideration, receipt of which is hereby acknowledged, the undersigned hereby grants to Axis Health System, its agents, employees, licensees, and successors in interest (collectively, the “Released Party”) all ownership rights and the absolute and irrevocable right and permission to copyright, use and publish the photo that has been, or is being, obtained pursuant to this “Consent and Release”.


The photo may be copyrighted, used and/or published individually or in conjunction with other photography, video works, and recordings and in any medium (including without limitation: print publications, public broadcast, social media, fundraising videos, promotional materials, newsletters, publicity, and advertising) and for any lawful purpose, including without limitation: trade, exhibition, illustration, promotion, publicity, advertising, and electronic publication.


The undersigned represents and warrants that (i) no other party has been granted an exclusive license with respect to the photo, and (ii) no other party’s authorization or consent is required with respect to the permission granted to the Released Party under this “Consent and Release.” The undersigned waives any right that the undersigned may have to inspect or approve the Released Party’s use of the photo or the advertising copy or printed matter that may be used in connection with the use and/or publication of the photo. The undersigned releases the Released Party (and all persons acting under its permission or authority) from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity, or any other claim related to the photo (collectively, “Claims”). This release includes, without limitation, any Claims related to blurring, distortion, alteration, optical illusion, digital alteration, use in composite form, whether intentional or otherwise, or use of a fictitious name that may occur or be produced in the processing or publication of the photo.


THE UNDERSIGNED WARRANTS THAT THEY HAVE READ THIS “CONSENT AND RELEASE” AND UNDERSTAND THAT THEIR SIGNATURE INDICATES THEIR ACCEPTANCE OF THE TERMS CONTAINED THEREIN.

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