Event Sign Up
Sharon Sokolik & Associates Groups and/ or Social Thinking Events
Client Information
Full Name of Client
*
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Age
Email of Participant (18 & older) or Parent/Guardian
*
example@example.com
Phone Number
Authorization and Release Agreement
Please check the appropriate boxes.
I allow Sharon Sokolik & Associates to take or capture photos and videos.
I authorize Sharon Sokolik & Associates to use the materials for the following purposes: advertising, marketing, educational lessons, commercial or non-commercial purposes
I grant Sharon Sokolik & Associates permission to use my photos and videos on Youtube, Vimeo, Facebook, Twitter, Instagram, and other social media platforms.
I understand Sharon Sokolik & Associates does not permit staff and volunteers to using any personal equipment to take photos and recordings of children. Only cameras or devices belonging to Sharon Sokolik & Associates should be used.
I release Sharon Sokolik & Associates from all liability and obligations from any claim for injury, illnesses, claims, or demands.
I, the undersigned, hereby agree that I have read this agreement and bounded by it.
Please check below if you DO NOT give permission.
I DO NOT consent to photographs being taken.
Client Signature
Date Signed
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Month
-
Day
Year
Date
Name
First Name
Last Name
Submit
Submit
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