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Life Enriching Communities Photo Consent - 2025

PHOTO CONSENT AND RELEASE

For the purpose of advertising and publicity, including websites and/or social media applications, and without any restrictions on where it may be seen or how many times it may be used, I hereby consent to the unrestricted use by Life Enriching Communities and its affiliated entities, officers, directors and employees (collectively “LEC”), their successors, assigns, agents and others authorized by LEC, of the following:

(1) my name

(2) my picture, portrait and likenesses in any form, including physical or digital videotape or film, whether retouched, modified, super-imposed or otherwise

(3) related quotes or statements I made, which may include changes to the language as long as they do not materially change the substance of my statements

Because names and photographs, among other things, are considered identifiers under HIPAA privacy laws, I understand that my personal information referenced above may be considered protected health information (PHI), and that this consent will also act as my HIPAA release for LEC to use only that PHI above and only as specifically described. Therefore, by signing below, I hereby unconditionally consent to such use and disclosure, and I understand that: (i) this authorization is voluntary and I may refuse to sign it; (ii) I am not required to sign this authorization as a condition of receiving treatment or payment for health care through LEC; and (iii) information that is used or disclosed pursuant to this authorization may be redisclosed by a receiving person or organization and, upon redisclosure, may no longer be protected by federal privacy law. I further understand that I may revoke my consent and this release at any time prior to its expiration date by sending a written notice to the LEC Privacy Officer, 6279 Tri-Ridge Blvd., Loveland, OH 45140. I understand that a revocation will not have any effect on any actions that took place before LEC received my revocation notice.

I also hereby waive any right to compensation and any right that I may have to inspect or approve any use of my above information, and I release LEC and all persons acting by its authority from any or all claims and liabilities of any kind because of such use. I also understand that LEC may decide not to, and is under no obligation to, use any of my information covered by this consent and release.

I represent and warrant that I have every legal right to give this consent and release, and that it does not in any way conflict with any existing commitments or other representations on my part.

This consent and release expires three years from the date of my signature unless previously revoked by me in writing.

April 16, 2026

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April 22, 2025 12:47 pm EDT

Life Enriching Communities Photo Consent - 2025 Uploaded by Janelle Behm - mktrequest@lec.org IP 66.161.143.2