By signing this Photo, Video and Sound Recording Release and Consent Form, you are irrevocably giving permission to the Omix Therapies officers, agents, employees, successors, licensees, and assigns to take and use photographs, video or sound recordings of you and your child for training and educational purposes. This is completely voluntary and up to you.

Your consent to the use of the photographs, video and sound recordings and your image, likeness, appearance, and voice is for forever. You will not receive compensation for the use of your image, likeness, appearance, and voice now or in the future. Omix Therapies may use the photographs, video and sound recordings containing your image, likeness, appearance and voice in any manner or media, including use on web pages. The photographs, video and sound recordings may be used in whole or in part, alone or with other recordings. The photographs, video and sound recordings may be used for any educational, institutional, scientific or informational purposes whatsoever, but not for any commercial uses. Omix Therapies has the right and may allow others outside the company to copy, edit, alter, retouch, revise and otherwise change the photographs, video and sound recordings at the company’s discretion. All right, title, and interest in the photographs, video and sound recordings belong solely to Omix Therapies.

You further give permission to Omix Therapies to use your name, biography, and any other personal data, events, or other material in or in connection with any such uses of the photographs, video and sound recordings.

I understand and agree to the conditions outlined in this photograph, video and sound recording release and consent form. I irrevocably give consent to Omix Therapies and the company’s officers, agents, employees, successors, licensees, and assigns forever to make use of my image, likeness, appearance, and voice in photographs, video and sound recordings as described above. I acknowledge that I am fully aware of the contents of this release and am under no disability, duress, or undue influence at the time of my signing of this instrument.