Bike Fit Waiver
By clicking the items below, I acknowledge and agree to the following statements regarding my bike fit today and other successive appointments/meetings:
Email address *
Full Name: *
Your answer
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USE &/OR DISCLOSURE OF IMAGES, VIDEOS, WRITTEN OR VERBAL TESTIMONIALS *
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Permission to interview, film, photograph, tape, or otherwise make a video production of me and/or record my voice.
Permission to use my name
Permission to use quotes from the interviews(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me and/or recording o f my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical medial and/or in mailins for education and awareness.
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This form was created inside of Fit & Function Therapy Solutions, PLLC.