• Photography and Publicity Release Form

    I give Early Autism Services (EAS), permission to use my child's and/or my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of EAS activities. I agree that EAS has complete ownership of such pictures, etc. including the entire copyright, and may use them for any purpose consistent with EAS missions. These uses include, but are not limited to illustration, bulletins, exhibitions, videotapes, materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation, etc for the use of such pictures, etc. and hereby release EAS and its agent and assigns from any and all claims which arise out of or are in any way connected with such use. I understand that if I wish to rescind consent for using photos/videos I can do so, without penalty, by emailing info@earlyautismservices.com.
  • Max. file size: 128 MB.
    This field is only used for team members who are submitting an already completed printed copy of this waiver on behalf of a client.