I do hereby consent and agree that Powered to Move, and all other affiliates/ programs, its employees and agents have the right to take photographs, videotape, or digitally record me during my participation in their Adapted Fitness Program to use in any and all media forms including; advertising, publications, website, internet and social media. This (these) photograph(s) may be used indefinitely as part of the above mentioned program and may also be used to promote to educational or health professionals, referral sources, and/or the general public in print and/or electronic format. I do hereby release Powered to Move, and all other affiliates/ programs, its employees and agents, and all rights to exhibit this work of myself in print and electronic form for publicity or privately.