nb Photography and Video Waiver and Release

Photography and Video Waiver and Release
Clinician*
I grant to neuroBridge, LLC, its representatives and employees, the right to take photographs and/or video of me and my child in connection with the evaluation and therapy sessions described in this Agreement.

I understand and agree that these materials will become the property of NeuroBridge, LLC.
Signature of Parent or Guardian for Minor Child*

Clear
Printed Name*

First NameLast Name
I authorize neuroBridge, LLC, the copyright, use of, and publication rights of the photographs taken for the purposes of marketing and training to educate teachers, staff, and client parents.

I authorize neuroBridge, LLC, to use the photographs and videos for training and educating patients, parents, and teachers.

I agree that neuroBridge, LLC, may use such photographs of me and my child with or without my name and for any lawful purpose, including the items mentioned above.
Signature of Parent or Guardian for Minor Child*

Clear
Printed Name*

First NameLast Name
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