Perfectly Bare Laser & Esthetics

• I understand that such consent is voluntary.
• I understand that I may refuse to sign this authorization and such refusal will have no effect on the medical treatment
• I understand that such photographs, videos or case histories may be published by Perfectly Bare Laser and Perfectly Bare Esthetics and/or any party acting license and authority in any print, visual or electronic media including, but not limited to, training manuals, and teaching courses, books, magazines, and internet websites, for the commercial, non profit and/or educational of informing others about non surgical aesthetic treatment methods.
•   I understand that such photographs, videos or case histories may be published by Perfectly Bare Laser & Perfectly Bare Esthetics and/or any party acting  under their license and authority in any print, visual or electronic media including, but not limited to, training manuals, presentations and teaching courses, books, magazines, and internet websites, for the commercial, non-profit and/or educational purpose of informing others about non-surgical aesthetic treatment methods.
• I release and discharge Perfectly Bare Laser & Perfectly Bare Esthetics and all parties acting under their license and authority from all rights that I may the photograph, and from any claim that I may have relating to such use in publication, including any claim for payment in with distribution or publication of the photographs.
• I understand that in some circumstances the photographs may portray features, which shall make my identity visble.

I have read the above Authorization and Release.

I am the parent, guardian, or conservator of a minor. I am authorized to sign on his/her behalf and I give this authorization as a voluntary contribution in the interest of public education.