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ReLive Weight Loss Photo Release

Please complete the following information. Participation in our Before & After photo program is important to you success. Should you wish to document your journey, this would cover the release of video content testimonials and success as well. Thank you!

Purpose of consent: By signing this form, you are consenting to allow and any associated staff members to use and distribute your photo along with your client testimonial.

Right to revoke: You have the right to revoke this release at any time by providing written notice of your revocation and submitting it to us.

Please understand that revocation of this release will not affect any action or the staff took in reliance on this release before receiving your revocation.

  • I hereby grant permission to allow to use the photograph of me shown below in conjunction with my client testimonial. I hereby agree and acknowledge that my photo will be released to the public relations efforts of.
  • I further acknowledge and agree that my photo may be used by the media.
  • I waive the right of prior approval and hereby release from any and all claims for damages of any kind based on the use of photo or information contained in my testimonial.
  • By signing below, I agree and acknowledge that I have read and understand the above release and agree to all terms described.
  • I am of legal age and freely sign this release.