Consent Form

Please fill out this consent form. Thanks!

Health History (Check if applicable)

With giving my name and checking the box, I give my consent to participate in MSforward wellness program.  I have consulted with my doctor/physician and they have approved my participation in the program. The MSforward staff will take every precaution to avoid injuries, however, should injury result from participation in the classes, I assume full responsibility.  

By providing my name and checking the box, I hereby grant MSforward permission to use my likeness in a photograph in any and all of its publications, live streaming/recordings, or in video presentations, including Web site entries and promotional materials without payment or any other consideration.   

I understand and agree that these materials will become the property of MSforward and will not be returned.   

I hereby irrevocably authorize MSforward to edit, alter, copy, exhibit, publish or distribute this photo, broadcast recording or video for purposes of publicizing MSforward or for any other lawful purpose.  In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.   

Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.  

 

I am 18 years of age and am competent to contract in my own name.  I have read this release before checking the box below and I fully understand the contents, meaning and impact of this release. 

Today's Date: 12/9/2022