*I, the undersigned, hereby authorize Brave Hearts Children's Network Inc. to use photographs, video footage, and written narratives featuring myself and/or my child, mentioned below, in various forms of media.

*Release of Liability: I understand that by consenting to the use of these materials, Brave Hearts Children's Network Inc. is not liable for any claims or demands arising from their use. This release is given freely without promise or inducement.

* Legal Guardian Certification: I certify that I am the legal guardian of the child listed below, and I have the authority to act on their behalf regarding the permissions granted in this form.

Confirmation and Agreement: By signing below, I confirm that I have carefully reviewed the information provided and that all details are correct. I acknowledge my understanding of the terms outlined above and agree to the use of the promotional materials.

Date

I consent to receive email communications, including marketing updates, from Brave Hearts Children's Network Inc.