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  • Healing Helps

    An Interactive Grief Workshop
  • Format: (000) 000-0000.
  • Will you be able to attend the entire workshop? 10am- 2pm*
  • Which topic interest you the most? Number them in order.*
    Rows
  • Liability Waiver and Release

  • I hereby grant permission to The Wallace Foundation, its representatives, and authorized partners to photograph, record, and otherwise capture my image, likeness, voice, and participation during this event.


    I authorize The Wallace Foundation to use, reproduce, edit, distribute, and publicly display these materials in any format, including but not limited to print, digital, social media, and promotional or educational content, without further notice or compensation.


    I understand and agree that all media captured will become the property of The Wallace Foundation.


    I hereby release, waive, and discharge The Wallace Foundation, its officers, directors, employees, volunteers, and affiliates from any and all claims, demands, or causes of action that I may have arising out of or in connection with the use of such photographs, videos, or recordings, including but not limited to any claims for invasion of privacy, defamation, or misappropriation of likeness.


    I further agree to indemnify and hold harmless The Wallace Foundation from any liability, damages, or expenses resulting from my participation or the use of these materials.


    I understand that participation in media is voluntary and that I may withdraw my consent in writing at any time; however, I acknowledge that any materials already published or distributed may continue to be used.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: