I grant to Borello Orthodontics, its representatives and employees the right to take photographs of me and my property in connection with the above- identified subject. I authorize Borello Orthodontics, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that Borello Orthodontics may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
I have read and understand the above: