Social Media Release

I do hereby authorize and grant permission to Bryan Sibley, MD, FAAP to use photographs, images, or video of me and/or my child(ren) or written testimonials or letters to use as the above mentioned deems necessary for the purpose of in-office display, publication in newspapers, magazines or other printed or digital media, for broadcast by means of radio and/or television transmission, or for display on Bryan Sibley, MD, FAAP website(s) or online social media page(s), including, but not limited to, Facebook, Instagram and TikTok. I understand that these photographs, images, videos or testimonials may be edited, modified, or retouched, at Bryan Sibley, MD, FAAP’s discretion.

As such, I agree to forever hold Bryan Sibley, MD, FAAP and its officers and employees free and harmless from any and all liability arising out of the use of these photographs, images, videos, testimonials or letters and subsequent publication or broadcasting and release and forever discharge from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this release. I hereby release and forever discharge Bryan Sibley, MD, FAAP from any and all claims and demands arising out of or in connection with the use of these photographs, images, videos, testimonials or letters, including but not limited to any and all claims for libel. I understand that I have submitted these photographs, images, video, testimonials or letters under my own free will, and so assume full responsibility.

1211 Coolidge Blvd. | Suite 300 | Lafayette, Louisiana 70503 | 337-289-0042 | info@dribsibley.com

In the Burdin Riehl Building next to Lafayette General Medical Center.

M-TH: 8-11:45am, 1-5pm | F: 8-11:45am