Consent Form

Photo/Video/Audio Consent Form

I, the undersigned, do hereby consent to the use by Owl Orthodontics of my image, voice or both, in (1) the video production; and (2) any video or photograph reproduced either in whole or in part stemming from the production, regardless of whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of Owl Orthodontics.

In addition, I waive all claims to compensation or damages based on the use of my image and/or voice by Owl Orthodontics, or any of its clients, partners or subsidiaries. I also waive my right to inspect or approve the finished video production.

I agree that all such photographs and video and/or audio recordings and any reproductions thereof, and all plates, negatives, recording tapes and digital files shall remain the property of Owl Orthodontics, unless otherwise noted.

I warrant that I am at least 18 years of age and I am competent in my own name insofar as this consent is concerned. I further attest that I have read this consent form and fully understand its contents.

Guardian Name:
Participant Name: