Support ArtWorks and give pediatric patients access to the healing power of art.


ArtWorks Release Form

The undersigned hereby authorizes ArtWorks, The Naomi Cohain Foundation, Inc. (“ArtWorks”) to use the name, age, healthcare agency affiliation, and likeness of the participant identified below (“Participant”), including but not limited to as may be captured in photographs, audio, videos, artwork, quotes, and any other material or information provided by or on behalf of Participant, or created by Participant, in connection with ArtWorks’ programs (the “Materials”). Participant hereby releases ArtWorks and any affiliated or related persons or entities from any and all claims and causes of action based upon ArtWorks’ use of the Materials, and grants ArtWorks permission to use, publish, exhibit and/or reproduce the Materials in any manner and in any and all media now known or later developed, without obligation to pay Participant any royalty or compensation of any kind. Such rights include but are not limited to use in connection with advertising, social media, publicity, marketing, fundraising, promotional and other commercial purposes.

Participant also grants ArtWorks a perpetual, royalty free, irrevocable, transferable license to any art, writings or other works of authorship (the “Works”) created by Participant in connection with any ArtWorks program. Such license includes but is not limited to: (i) copyrights; (ii) rights to reproduce, display, perform, sell and distribute the Works or copies thereof, in whole or in part, in any form or medium whatsoever; (iii) moral rights, rights to decide whether and in what manner the Works shall be published, advertised, publicized, performed or exploited; (iv) rights to create derivative works and alter, expand, adapt, modify and make any arrangements of the Works; and (v) all rights to enforce, and to seek and secure any statutory protections, as to the Works, including the collection of damages. The foregoing grant shall be limited to those uses which ArtWorks believes, in its sole and absolute discretion, will further ArtWorks’ mission and purpose. Participant hereby releases ArtWorks from all claims, demands and liabilities whatsoever in connection with the foregoing.  

  • Please enter a number from 1 to 99.
  • (Parent/Guardian must sign for a child 18 and under. If participant is over 18, he/she may sign)
  • MM slash DD slash YYYY
  • ArtWorks: 96 Engle Street, Suite 120, Englewood NJ 07631
    If you have any questions please contact Esther Jun, Program and Development Coordinator at 201-608-0146 or