Connected Horse Confidentiality Agreement and Photo/Video Release
Please complete this form to provide your consent for confidentiality and optional photo/video release as part of the Connected Horse program.
Confidentiality Agreement
Information regarding participants in Connected Horse, an equine-guided program, is kept confidential. I understand and agree that my participation in the program is conditioned upon my agreement to maintain the confidentiality of all other participants and will not release or publish the identities or information regarding the participation of any other person without their written authorization.
Participant Name
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Legal Representative (if applicable)
Signature of Participant or Legal Representative (Confidentiality Agreement)
*
Date (Confidentiality Agreement)
*
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Month
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Day
Year
Date
Photo and Video Release (Optional)
I give Connected Horse, the barns where Connected Horse Workshops are held, the right and permission to use a photograph(s) and or video(s) of me in its promotional or research materials and publicity efforts. I understand that the photographs may be used in a publication, print ad, direct-mail piece, electronic media (e.g., video, CD-ROM, internet/WWW), or other form of promotion. I release Connected Horse, its officers and directors, the photographer, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use.
Signature of Participant or Legal Representative (Photo and Video Release)
Date (Photo and Video Release)
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Month
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Day
Year
Date
Submit
Submit
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