Video Release Form
By signing this form, you are granting permission to Dr. Kaylee Garrett Simmerman, PT, DPT, owner and founder of FEMMEmpowerment and Advocacy, the irrevocable and unrestricted right to reproduce video testimonials or demonstrations of techniques of you for the purpose of publication, promotion, illustration, advertising, and marketing, in any manner or in any medium.
You hereby release Dr. Simmerman and FEMMEmpowerment and Advocacy for all claims and liability relating to said images or videos. Furthermore, you grant permission to use your statements that were given during the process, with or without your name, for the purpose of advertising and marketing. You waive your right to any compensation.
By clicking the box below, you agree to the above terms:
Yes, I agree to the above terms.
Please Write Your Name and Email:
Never submit passwords through Google Forms.
This form was created inside of FEMMEmpowerment and Advocacy, LLC.
Terms of Service