Photo Upload & Consent Form

I hereby grant the Personalised 4 Autism Limited, its directors, officers, employees, agents, and designees (collectively “P4A”) non-revocable permission to capture my image and likeness in videotapes, motion pictures, recordings, or any other media (collectively “Images”). I acknowledge that P4A will own such Images and further grant P4A permission to copyright, display, publish, distribute, use, modify, print and reprint such Images in any manner whatsoever related to the P4A business, including without limitation, publications, advertisements, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by P4A prior to its use. I forever release and hold P4A harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assignees and personal representatives.
Click or drag a file to this area to upload.


Please check one of the following two options
I understand that my photo(s) may never be revoked.
I understand that my consent may be withdrawn after written confirmation sent to