Read Microsoft Word - VIDEO_PHOTO RELEASE 2008.doc text version

Photo/Video Release Waiver

I hereby grant Robyn Pester Physical Therapy, Inc. permission to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Robyn Pester Physical Therapy, Inc., in perpetuity, and for other use by Robyn Pester Physical Therapy, Inc. or it's employees including but not limited to educational purposes. I will make no monetary or other claim against Robyn Pester Physical Therapy, Inc. for the use of the photograph(s)/video. Patient Name _________________________________________________________________ Parent or Guardian Name (if patient is under 18) _____________________________________ Signature _________________________________________ Date_____________

Information

Microsoft Word - VIDEO_PHOTO RELEASE 2008.doc

1 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

1095694


You might also be interested in

BETA
Microsoft Word - VIDEO_PHOTO RELEASE 2008.doc