Photography Release for Minor Child or Children for use by Fertility Solutions NE I hereby authorize Fertility Solutions NE, to publish photographs or images provided by myself of the child/children listed below for use in the Fertility Solutions NE’s print, online and video-based marketing materials, as well as other Company publications. I hereby release and hold harmless Fertility Solutions NE from any reasonable expectation of privacy or confidentiality for myself and for the minor child/children listed below associated with the images specified. Further, I attest that I am the parent or legal guardian of the child/children listed below and that I have full authority to consent and authorize Fertility Solutions NE to use their likenesses and names. I further acknowledge that participation is voluntary and that neither I, the minor child/children will receive financial compensation of any type associated with the taking or publication of these photographs or participation in Fertility Solutions NE marketing materials or other company publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release Fertility Solutions NE, its contractors, its employees and any third parties involved in the creation or publication of Fertility Solutions NE publications, from liability for any claims by me or any third party in connection with my participation or the participation of the minor child/children listed below. AuthorizationDate *First Name *Last Name *Consent *I authorize this release and submit my typed name as an electronic signature.Email Address *Phone NumberStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeMessage0 / 180Name, Age and Date of Birth of Minor Child/Children:Child's NameDate of BirthPhoto UploadChoose FileNo file chosenDelete uploaded fileAccepted file types: jpg, png, jpeg, heicChild's NameDate of BirthPhoto UploadChoose FileNo file chosenDelete uploaded fileAccepted file types: jpg, png, jpeg, heicChild's NameDate of BirthPhoto UploadChoose FileNo file chosenDelete uploaded fileAccepted file types: jpg, png, jpeg, heicSend MessagePlease do not fill in this field.