Media Consent & Release Form

Please fill out this media consent and release form so our photographer can take pictures/videos documenting our magical time together doing our classes, excursions and events.

Name*
First Last
I hereby give Adriana (Adri) Kyser | Inner beauty Yoga LLC, hereinafter referred to as the producers, the videographers, and/or the photographers, permission to use and/or publish, photographic portraits or pictures, audio tapes, or videos of me.
In which I may be included whole or in part, or composite or creatively for art, advertising, trade, broadcast, or any printed matter in conjunction therewith.
Initials*
Your Name
Your Name
Your Name
I hereby waive my options to inspect and/or approve the finished product, i.e., videotape, sound tract, photo, etc. or the advertising copy of printed material that may be used in connection to promoting Adri's classes, events, retreats and brand.
Initials*
Your Name
Your Name
Your Name
I hereby release, discharge, and agree that Adriana (Adri) Kyser | Inner beauty Yoga LLC, its assigns, heirs, employees, client, etc., from and against any liability by virtue of any creative blurring, alteration, optical illusion, or use in composite form, that may occur or be produced in the taking of said pictures, audio tapes, or videos, or in any processing tending toward the completion of the finished product, its publication, distribution, or broadcast of the same; and from any adverse outcome whatsoever therefrom.
Initials*
Your Name
Your Name
Your Name
I hereby certify that I am eighteen years of age, and competent to contract in my own name in so far as the above is concerned.
Initials*
Your Name
Your Name
Your Name
I have read the foregoing release, authorization and agreement, before affixing my signature below, and warrant that I fully understand the contents thereof.
Initials*
Your Name
Your Name
Your Name
These paragraphs define our responsibility with respect to our retreats and contracted services. Please read carefully. Your signature below represents acceptance of the following terms and conditions.
Signature*
Your Name
Your Name
Your Name
Date*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternate Phone
Email*
Please submit this form before May 28th, 2017.
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