Video/photo Consent Form - Athletix Rehab printable pdf download

PHOTO/VIDEO CONSENT & RELEASE

During your treatment, we may verbally ask your permission to take a photo/video. In the event that you

grant your approval, we also need a signed written consent form as seen below. Thank you for your

cooperation.

1. I, ____________________________, hereby grant to ATHLETIX REHAB & RECOVERY, LLC.,

the unlimited right and permission to use in perpetuity my photograph, video footage, actions, and/or

testimonial, either alone or accompanied by other material, in any manner and in any media, throughout

the world, at any time, for any and all lawful purposes, including but not limited to, all promotion,

marketing, advertising and publicizing of ATHLETIX’s services, or ATHLETIX’s clients’ products or

services.

2. I acknowledge that I shall have no right of approval, no claim to compensation, and no claim

(including, without limitation, claims based upon invasion of privacy, defamation, or right of publicity)

arising out of any use, blurring, alteration, distortion, illusionary effect, faulty reproduction,

fictionalization or use in any composite form of my name, picture, and/or video footage. I acknowledge

that neither ATHLETIX nor any other party, or any agent or attorney of ATHLETIX or any other party,

has made any promise, representation or warranty whatsoever, express or implied, not contained herein

concerning the subject matter hereof, to induce me to execute this document.

3. I acknowledge that any pictures and/or video recordings taken of me by ATHLETIX or any third

party contracted by ATHLETIX to perform such actions are or will become the sole property of

ATHLETIX.

4. I understand that nothing contained herein shall constitute any obligation by ATHLETIX to make use

of any of the film, photographs, videos, or recordings of me.

5. I hereby hold harmless, release and forever discharge ATHLETIX from any and all claims, demands,

and causes of action which I, my heirs, representatives, executors, administrators, agents, successors,

assigns, or any other person acting on my behalf or on behalf of my estate have or may have by reason of

this authorization.

6. I acknowledge that I am over the age of 18, and that I have read, understand and agree to all of the

terms and conditions presented in this Consent and Release, and that I have the full and exclusive

authority to grant the rights granted hereunder.

7. This Consent and Release shall be governed by and interpreted in accordance with the laws of the

State of Florida.

___________________________

Signature

___________________________

Date

Video/photo Consent Form - Athletix Rehab