PHOTO AND TESTIMONIAL/STATEMENT RELEASE
I consent for all purposes to the reproduction and/or use of photographs of me and/or my children and to any testimonials/statements made by me and/or my children by HealthFirst Family Care Center, Inc. in all forms and media and in all manner including advertising, trade display, editorial, art and exhibition.
In giving consent, I release HealthFirst Family Care Center, Inc. from liability for any violation of my personal or proprietary right I may have in connection with such reproduction or use.
Signed: _________________________ Children: _________________________
Witness: _________________________ _________________________
Date: _________________________ __________________________