Media Consent and Release Form

Includes videography/photography
I understand and agree to the following:
1. Consent to Use: I grant High Level Interactions, FocusCare and any affiliates the irrevocable right and permission to use, reproduce, distribute,
and publicly display any photographs, audio recordings, or videos in which I appear, for promotional
materials, including but not limited to brochures, websites, social media platforms, newsletters,
presentations, and any other marketing or informational materials associated with High Level Interactions and FocusCare.
2. Release of Liability: I release High Level Interactions, FocusCare and any affiliates and its representatives from any and all claims, liabilities,
and demands arising out of or in connection with the use of my likeness, including but not limited to
any claims for defamation, invasion of privacy, or infringement of any personal or proprietary rights I
may have.
3. Confidentiality: High Level Interactions, FocusCare and any affiliates agrees to exercise reasonable efforts to protect the privacy and
confidentiality of any personal information or health-related information disclosed in conjunction
with the use of my likeness. However, I understand and acknowledge that the Group cannot guarantee
absolute confidentiality or security.
4. Compensation: I understand that I will not receive any monetary compensation or royalties for the
use of my likeness as described in this consent and release form.
5. Revocability: I acknowledge that this consent and release form is voluntary and that I may revoke
this consent at any time, provided that High Level Interactions, FocusCare and any affiliates receives written notice of my revocation. However, I
understand that the Group may have already used my likeness in promotional materials before
receiving the revocation notice, and in such cases, High Level Interactions, FocusCare and any affiliates will not be obligated to remove or
discontinue the use of my likeness.
6. Minors: If the participant is under 18 years of age, I, as the parent or legal guardian, hereby consent
to the terms outlined in this form on behalf of the minor participant.
By signing below, I confirm that I have read and understood the terms of this photo consent and release
form and agree to be bound by them.

Medical Treatment:

I give permission for my child to receive CPR and first aid from qualified staff if I cannot be contacted. I also allow my child to be transported by ambulance to an emergency center. I consent to the disclosure of health information and necessary medical, surgical, and hospital treatments, including anesthesia, tests, x-rays, transfusions, injections, and medications.

Release From Liability:

I acknowledge that FocusCare, GMA, High Level, LMP and it's affiliates "The Groups"  will strive to ensure safety, but accidents may occur during dance, youth sports, and transportation. I assume these risks and release Focuscare LLC and its agents from all liability for any damage, loss, or injury, whether due to ordinary negligence or otherwise. I have read and understand this agreement.

 

Parental Permission For Authorization:

I GRANT MY CHILD or CHILDREN, AND LEGALLY GIVE AUTHORIZATION TO GRANT, FOCUSCARE LLC "THE AFFILIATE GROUPS" PERMISSION TO PROVIDE TRANSPORTATION, THERAPEUTIC ACTIVITIES, AND ATHLETIC BEHAVIORAL SERVICES TO MY CHILD.