I give WagnerLax, and its assignees and transferees, irrevocable and unrestricted right to use, reproduce, copyright, and publish photographs and/or video footage taken of me [or my child] for WagnerLax marketing and/or promotional materials, including, but not limited to advertisements, website, publications, social media accounts, and any other lawful purpose. By signing below, I give up any rights I may have to such photographs or images, including inspecting or approving the photograph or video used. I hereby release WagnerLax and its representatives, employees, agents, and assigns, from all claims and liability relating to these photographs and video footage.

I understand that:
a. I have the right to withdraw my consent for WagnerLax to use these photographs or videos in the future by putting a request in writing.
b. If I refuse to sign this Consent, my service provided by WagnerLax will not be affected.
c. The photographs or videos may be used by others and once disclosed by WagnerLax may no longer be protected by federal or state privacy laws.

I do not authorize WagnerLax or its employees to use photographs or videos of myself in whole or in part for marketing and/or promotional purposes. I hereby confirm that I am of legal age (over 18) and have every right to contract in my own name. I will notify the photographers and videographers in my vicinity that I do not wish to be photographed or videographed. In signing this form, I understand that WagnerLax will make reasonable efforts to avoid access to, or remove, my image, for all purposes identified herein.