Photography & Media Release Form

Southtowns Colon Hydrotherapy: Go To Wellness Center

6510 Milestrip Road Orchard Park, NY 14127 (716) 508-7367 gotowellnesscenter@gmail.com www.gotowellnesscenter.com

I, the undersigned, hereby acknowledge that this Photography & Media Release Form became effective on the date signed below and that I have entered into this agreement freely and voluntarily. I authorize Southtowns Colon Hydrotherapy: Go To Wellness Center to edit, change, copy, alter, and make use of all photographs of me to be used for promotional and/or marketing materials. I understand that I will not be entitled to any monetary payment, royalty, or compensation under this agreement. I expressly authorize and permit Southtowns Colon Hydrotherapy: Go To Wellness Center the unlimited use of my photograph, image, and likeness for lawful purposes, including publication on the internet, in print, or other media. I hereby release and hold harmless Southtowns Colon Hydrotherapy: Go To Wellness Center, its owners, employees, and contractors from any and all claims, rights, or liability arising from the use of my image or