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I,                                   , grant permission to iFlourish, inc, hereinafter known as the "media" to use my image (photographs and/or video) for use in media publications including:

Media Release Form

             - I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. (Adults)

             - I am the parent or legal guardian of the below named child. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release.  I understand that I am free and knowledgeable acceptance of the terms of this release.

 Signature:                                                                      Date:

 Name (Print):

I hereby approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

Please initial the paragraph below which is applicable to you:

(Parent or guardian signature if under 18 years old)

Thanks for submitting!

©2019 iFlourish,inc.

                                         Charlotte,NC

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