Tell Us Your Story
Thank you for taking the time to share your Peptamen® Story with us for the opportunity to be featured in the Powered by Peptamen® Stories Program. Please fill out the form below and sign the consent form.
We appreciate you sharing your tube feeding story with the Peptamen® Team for the opportunity to be featured in the Real Stories Program. The Real Stories Program shares success stories in a variety of mediums including but not limited to on social media platforms, websites, and Nestle’ internal and external marketing materials and emails. To have your story, testimonial, photograph, or video shared in the Real Stories Program, we kindly request your review and consent of the following:
By indicating your agreement to this document, you are authorizing NESTLÉ HEALTHCARE NUTRITION, INC. of Bridgewater, New Jersey, and its parent, subsidiaries, affiliates, successors and assigns and those acting on its authority (collectively, "NESTLÉ"), to use your name, your story, your testimonial content and interview comments, biographical information, and any photographs or videos submitted by you or taken by NESTLÉ in connection with your experience using Peptamen® formulas (hereinafter, “Materials”) with no compensation or other consideration in any form either now or in the future. You acknowledge that your submissions can be shared by NESTLÉ and edited and modified through the copyright process prior to sharing.
You will also be allowing NESTLÉ to use, broadcast and publish your name on our internet communications (website, emails, social media, etc.), promotional materials, in print, at trade conferences, or any other lawful purpose whatsoever, in whole or in part, through any medium, existing now or developed in the future, anywhere in the world and in perpetuity. All rights to the Materials belong to Nestlé. To this end, your participation in the development of the Materials hereunder is a work-for-hire and, therefore, Nestlé shall be the author and copyright owner thereof for all purposes throughout the universe in perpetuity. If any provision of this Authorization and Release or applicable law or ruling does not fully vest in Nestlé any of the rights set forth herein, you hereby irrevocably grant and assign to Nestlé all rights not so vested.
You understand that Nestlé has the right to adapt, change, delete from and add to the Materials, and to use all or any part thereof in new versions, adaptations and other programs and audio-visual works without any approval by you, notice to or compensation to you in any form now or in the future.
Furthermore, you are acknowledging that you have the full power and authority to grant us all of the rights within this release form and waive any right to inspect or approve the finished product, advertising or other copy that may be used, including how it may be used.
Nestlé is not obligated to make any use of the Materials or the rights granted to Nestlé in this Authorization and Release.
Further, you agree to secure the authorization and release of any person that appears in the Materials for Nestle’s use.
You hereby waive, release and discharge Nestlé from any and all claims and demands arising out of or in connection with the use of the Materials (including your testimonial content, interview comments, photographs, videos, your likeness), including without limitation any and all claims for libel, defamation, claims for invasion of privacy, publicity or personality or similar matter, claims for infringement of “moral rights,” all rights under common law, the Lanham Act, the Copyright Act, and any and all claims for royalties or compensation.
You hereby acknowledge that your story and any comments accurately reflect your honest opinions and actual experience using Peptamen® formulas and that the facts and comments are true and correct to the best of your knowledge and belief. You knowingly and voluntarily authorize Nestlé to attribute such statements to you, which are unbiased representations of your own opinions, feelings, perceptions and/or beliefs and you shall immediately advise Nestlé in writing if your testimonial statements or interview comments and/or any elements thereof are no longer full, truthful, and accurate.
This Authorization and Release shall be governed by and construed in accordance with the laws of the State of Delaware, notwithstanding its conflict of laws principles. No modifications of this Authorization and Release or any of its terms shall be effective unless in writing signed by the duly authorized representatives of Nestlé HealthCare Nutrition, Inc. and you.
By clicking on the CONSENT box and completing your submission on the Real Stories Program page, you are indicating your agreement to this Authorization and Release and by doing so you certify you are currently of legal age (18+), have the right to agree to this Authorization and Release, have read this Authorization and Release fully and are fully familiar with its contents, and agree everything contained in this Authorization and Release is and shall be binding upon you, your agents, heirs, executors, administrators, representatives, successors and assigns.
We appreciate you sharing your tube feeding story with the Peptamen® Team for the opportunity to be featured in the Real Stories Program. The Real Stories Program shares success stories in a variety of mediums including but not limited to on social media platforms, websites, and Nestle’ internal and external marketing materials and emails. To have your story, testimonial, photograph, or video shared in the Real Stories Program, we kindly request your review and consent of the following.
By indicating your agreement to this document, you are authorizing NESTLÉ HEALTHCARE NUTRITION, INC. of Bridgewater, New Jersey, and its parent, subsidiaries, affiliates, successors and assigns and those acting on its authority (collectively, "NESTLÉ"), to use your name, and the name of your minor child(ren) indicated on the Real-Life Stories submission page (the “Minors”), your story, your testimonial content and interview comments, biographical information, and any photographs or videos submitted by you or taken by NESTLÉ in connection with your or the Minors’ experience using Peptamen® formulas (hereinafter, “Materials”) with no compensation or other consideration in any form either now or in the future. You acknowledge that your submissions can be shared by NESTLÉ and edited and modified through the copyright process prior to sharing.
You will also be allowing NESTLÉ to use, broadcast and publish your name and the name(s) of the Minors on our internet communications (website, emails, social media, etc.), promotional materials, in print, at trade conferences, on or any other lawful purpose whatsoever, in whole or in part, through any medium, existing now or developed in the future, anywhere in the world and in perpetuity. All rights to the Materials belong to Nestlé. To this end, your participation in the development of the Materials hereunder is a work-for-hire and, therefore, Nestlé shall be the author and copyright owner thereof for all purposes throughout the universe in perpetuity. If any provision of this Authorization and Release or applicable law or ruling does not fully vest in Nestlé any of the rights set forth herein, you hereby irrevocably grant and assign to Nestlé all rights not so vested.
You understand that Nestlé has the right to adapt, change, delete from and add to the Materials, and to use all or any part thereof in new versions, adaptations and other programs and audio-visual works without any approval by you, notice to or compensation to you in any form now or in the future.
Furthermore, you are acknowledging that you have the full power and authority to grant us all of the rights within this release form and waive any right to inspect or approve the finished product, advertising or other copy that may be used, including how it may be used. You further warrant that you are the parent or legal guardian of the Minors appearing in the Materials.
Nestlé is not obligated to make any use of the Materials or the rights granted to Nestlé in this Authorization and Release.
Further, you agree to secure the authorization and release of any person, other than the Minors, that appears in the Materials in the attached Addendum for Nestle’s use.
You hereby waive, release and discharge Nestlé from any and all claims and demands arising out of or in connection with the use of the Materials (including your testimonial content, interview comments, photographs, videos, your likeness and/or name or those of the Minors), including without limitation any and all claims for libel, defamation, claims for invasion of privacy, publicity or personality or similar matter, claims for infringement of “moral rights,” all rights under common law, the Lanham Act, the Copyright Act, and any and all claims for royalties or compensation.
You hereby acknowledge that your story and any comments accurately reflect your honest opinions and actual experience using Peptamen® formulas and that the facts and comments are true and correct to the best of your knowledge and belief. You knowingly and voluntarily authorize Nestlé to attribute such statements to you, or and the Minors, which are unbiased representations of your own opinions, feelings, perceptions and/or beliefs and you shall immediately advise Nestlé in writing if your testimonial statements or interview comments and/or any elements thereof are no longer full, truthful, and accurate.
This Authorization and Release shall be governed by and construed in accordance with the laws of the State of Delaware, notwithstanding its conflict of laws principles. No modifications of this Authorization and Release or any of its terms shall be effective unless in writing signed by the duly authorized representatives of Nestlé HealthCare Nutrition, Inc. and you.
By clicking on the CONSENT box and completing your submission on the Real Stories Program page, you are indicating your agreement to this Authorization and Release and by doing so you certify you are currently of legal age (18+), have the right to agree to this Authorization and Release, you are the parent or legal guardian of any of the Minors indicated on the Real Stories Program submission page and authorized to agree to this Authorization and Release on their behalf, have read this Authorization and Release fully and are fully familiar with its contents, and agree everything contained in this Authorization and Release is and shall be binding upon you, your agents, heirs, executors, administrators, representatives, successors and assigns.