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  • Connext Care Photo Release Form

  • It is the policy of Connext Care, LLC to ensure the right to confidentiality and/or anonymity of all individuals, representatives, parents, and guardians if they wish to be so protected. Realizing, however, that training, funding, and employment opportunities often arise due to public exposure, it is also our policy to encourage individuals, representatives, parents, and guardians to waive that right and to sign a photography/video waiver. Should you choose to sign this release, it is understood that you have in no way been coerced into signing but have signed of your own free will. 

    (For legally incompetent persons or individuals who are not capable of expressed and informed consent, the release must be signed by the individual's parent, guardian, or representative.) 

    This release is valid for one year from the date of the original signatures. A copy of this authorization and consent is as valid as the original, which is filed in the central file of the above-mentioned individual. 

     

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  • Upon submitting this form, you affirm that all your responsibilities and rights have been explained to you.

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