Consent | SAWPS

Photography Consent Form

Adult Participant Information

Today's Date

Month

Day

Year

Full Name

Phone

Add your text

Minor Children (Under Age 18)

Minor Children (Under Age 18)

List the names and ages of any minor children for whom you are giving consent. If none type N/A

Consent Authorization

I give permission for the South Asian Women Physicians Society (SAWPS) to use images or videos of my minor children listed above.

I understand that I may revoke this consent at any time by contacting SAWPS in writing, but the revocation will not apply to materials already created or published.

Usage Permission

SAWPS Website

SAWPS Social Media

Printed Materials (flyers, brochures, reports)

Educational or Professional Presentations

Release Agreement

I hereby release and discharge the South Asian Women Physicians Society from any and all claims and demands arising out of or in connection with the use of the images, including any claims for invasion of privacy, defamation, or financial compensation.

I affirm that I am atleast 18 years old and legally authorized to give consent for any listed minor children.

Signature (Type Name)