Free-Therapy Thursdays Audio/Video Waiver
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Welcome to Free-Therapy Thursdays!

All sessions will be conducted on Zoom. Both the audio and video will be
recorded. Participants are required to sign this video, photo and audio release/waiver,
which will allow Annelisa to use all, or various elements of these session recordings for
educational and/or promotional purposes, as needed.

All are welcome to participate. These sessions are open to new and on-going clients.
Participant Name *
Typing your name here designates you as the PARTICIPANT in this waiver.
I, the PARTICIPANT, hereby grant permission to, ANNELISA MACBEAN, PhD the rights of my image, in video or still, and the likeness and sound of my voice as recorded on audio and video. I understand that my image may be edited, copied, exhibited, published, distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally I waive any right to royalties or compensation arising or related to the use of my image, likeness, voice or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographical setting.

Photographic, audio or video recordings may be used for ANY USE which may include but is not limited to: 

• Presentations
• Courses
• Online/Internet Videos
• Media
 News (Press)

By signing this release, I understand this permission signifies that photographic, video and/or audio recordings of me may be electronically displayed via the Internet or in a public educational or promotional setting.

I will not be consulted about the use of the photographs or video recording for any purposes not listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of the sessions described in this agreement.

By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational or promotional purposes.

Full Name: *
Address: *
Phone Number: *
Email: *
Date: *
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/
DD
/
YYYY
I have read and agree to the terms listed above *
Required
Signature: *
Typing your name below denotes your signature and agreement to the terms listed above.
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