Media Consent I [Talent Name below ] hereby assign and grant Smart Solutions Rehab Group the right and permission to use and publish the photographs/film/video/electronic representations and/or sound recordings made of me on the date below and I hereby release Smart Solutions Rehab Group from any and all liability from such use and publication. I hereby authorize the reproduction, copyright, exhibit, broadcast, electronic storage and/or distribution of photographs/film/video/electronic representations and/or sound recordings without limitation across all media and in perpetuity at the discretion of Smart Solutions Rehab Group, and I specifically waive any right to any compensation I may have. Written Feedback(Required) I agree my written feedback may also be used for marketing purposes, such as testimonials on our website or in social media posts.Talent Name(Required) Talent - Date of Birth MM slash DD slash YYYY Address(Required)Phone(Required) If the person signing is under age 18 years or requires assistance with decision making, the parent or legal guardian/authorized representative must sign below. I hereby certify that I am the parent or legal guardian or authorized representative of the talent named above and I give consent without reservation to the foregoing on behalf of him or her.Name of representative Date of shoot MM slash DD slash YYYY Images & Attachments Drop files here or Select files Max. file size: 100 MB. CAPTCHA Δ
