PHOTOGRAPH/VIDEO/AUDIO-CONSENT AND WAIVER  I  hereby grant full permission to the Film LLC to prepare, use, reproduce,    publish, distribute and exhibit my name, picture, portrait, likeness, or voice,    or any or all of them in or in connection with the production of a motion    picture film, television videotape or live program, video recording, sound    track recording, or still photography in any manner including website    postings for educational, treatment, scientific, marketing, publication,    informational and any other professional purpose deemed necessary. I    hereby waive all rights of privacy or compensation which I may have in    connection with the use of my name, picture, portrait, likeness or voice, or    any or all of them, in or in connection with said motion picture film, television  videotape or live program, video recording, sound track recording, or still    photography and any use to which the same or any material therein may    be put, applied or adapted by the Film LLC, and any of its agencies.    Consent given below is valid until the deems it otherwise, or until consent    is revoked by he/she signed below.  I, (Participant Name) Please select grant permission for the use of my information as stated above by the  Film LLC.  Email Phone phone number Parent or Legal Guardian (if participant is a minor or unable to sign) Your signature