Video and Photo Release

Growing Healthy Children Therapy Services, Inc. DBA Growing Healthy Seasons is an educational organization. As such, we may video or photograph individuals participating in treatment, evaluation, or research projects, to ensure highest quality of care. The video and photos may include interviews, assessments, treatments, or group activities, and will be accessible only to your/your child’s treatment team at GHC. The rights, titles, and interests of these materials belong to Growing Healthy Children Therapy Services, Inc., DBA Growing Healthy Seasons, which reserves the right to edit the material.

In addition, I voluntarily consent to the taking of photographs or video of myself and/or my child, for the following additional purposes:

I understand I will not be compensated by any party. Although photographs and/or video images shared outside my/my child’s treatment team will be used without identifying information such as name, I understand someone may recognize me.

I further acknowledge by consenting to this, I agree that the use of any photographs and/or video images confers no rights of ownership or royalties whatsoever.

I hereby release Growing Healthy Seasons, its employees, and any third parties involved in the creation of or publication of educational or marketing materials, from liability for any claims by me or any third party in connection with my participation.

By signing this form, I confirm my understanding of this consent. If I wish to withdraw my consent in the future, I may do so via a written request submitted to Growing Healthy Seasons or by completion of a new form.