Written and/or Video Testimonial Consent and Release

  • The Centr
    PO BOX 44555, Boise ID, 83711
    800-608-1792

  • Date Format: MM slash DD slash YYYY
  • Authorization and Release Information

    I understand my testimonial as outlined above or in the video recorded of me (the “Testimonial”) and made on behalf of The Centr may be used in connection with publicizing and promoting The Centr. I authorize The Centr to use my name, brief biographical information, and the Testimonial as defined on this form or by me in this video.

    I hereby irrevocably authorize The Centr to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing The Centr's programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against The Centr for the use of the statement.

    In addition, I waive any right to inspect or approve the finished product, including written copy or edited video wherein my likeness or my testimonial appears.

    I hereby hold harmless and release The Centr from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

  • Date Format: MM slash DD slash YYYY