Consent to Photograph
Sign in to Google to save your progress. Learn more
I authorize Katy Smolik to photograph myself and/or my infant(s). I understand that these images will be used for the purpose of education and for the promotion of breastfeeding and lactation counseling. I consent to these images being published, exhibited, reproduced, copied, and used by the photographer/agency/institution noted above, or by anyone who has obtained permission to use these images ion any materials distributed by his/her/their agents. I understand that our names will never be used in connection with the images, and that our privacy will be protected.
Signature (consent provided by typing in your Full Name) *
*
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy