First Name

Last Name

Email Address

Telephone

Address

I grant to CARE YOGATHERAPY represented by AMPARO HERNANDEZ the right to take photographs of me and my property in connection with the above-identified subject. I authorize CARE YOGATHERAPY - AMPARO HERNANDEZ its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that CARE YOGATHERAPY - AMPARO HERNANDEZ may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I grant to CARE YOGATHERAPY represented by AMPARO HERNANDEZ the right to take photographs of me and my property in connection with the above-identified subject. I authorize CARE YOGATHERAPY - AMPARO HERNANDEZ its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that CARE YOGATHERAPY - AMPARO HERNANDEZ may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I agree

I have read the Release and Consent to Video and Photograph Form and fully understand its contents. I voluntarily agree to the terms and conditions stated above. I have agreed to submit this waiver by electronic means and I understand that an electronic signature is the same as a written signature. By filling in the form, and pressing the Send button, I am electronically signing my waiver. I have read the Release and Consent to Video and Photograph Form and fully understand its contents. I voluntarily agree to the terms and conditions stated above. I have agreed to submit this waiver by electronic means and I understand that an electronic signature is the same as a written signature. By filling in the form, and pressing the Send button, I am electronically signing my waiver. I agree