Please upload a video of your child walking that represents your child’s typical ability.
If they're not able to use a walker or pacer, you may upload a video of them trying to walk with your support.
Your child should be wearing their AFOs and shoes that they plan to use in the Trexo.
I, First Name* Last Name* , hereby agree and give my permission for Trexo Robotics Inc. to record, film, photograph, and videotape me/my child (herein collectively referred to as “IMAGES”) and to display, publish or distribute the resulting IMAGES for the purpose of publishing including Trexo Robotics Inc. videos, email blasts, brochures, newsletters, broadcasting on television and magazines and to use the IMAGES in electronic versions of the same publications or on the Trexo Robotics Inc.’s website or other electronic forms of media including social media.
I hereby waive any right to approve the use of these IMAGES now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these IMAGES.
I understand that the IMAGES may appear in electronic form on the internet or in other publications outside of Trexo Robotics Inc. 's control. I agree that I will not hold Trexo Robotics Inc. responsible for any harm that may arise from such unauthorized reproduction.
I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
* Please initial this line confirming that you have read this release before signing below, and you fully understand the contents, meaning and impact of this release.
Agreed and accepted for:Child’s name: * Address: Street Address* Address Line 2* City* Province* Phone: Phone Number* Signature Signature* Date: Date* PARENTAL CONSENT I certify that I am the parent or guardian of the individual above, Type a label* (Child's Name) , a minor under the age of eighteen years. I hereby agree to assume legal responsibility for his/her authorizations referred to in this General Media Release. Signature* Signature of Parent/Guardian Date Date* Name of Parent/Guardian: First Name* Last Name*