Permission to Use Photo Release Form - Molecular Hydrogen (H2) Targeted Methods

Beneficiary of the Molecular Hydrogen (H2) Targeted Methods or the Parent/Legal Guardian if the Beneficiary is a minor:

First Name *

Last Name

Phone (mobile) *

Email Address *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Today's Date *

About the Photo Release Form

This Molecular Hydrogen (H2) Targeted Methods Permission to Use Photo Release Form (the “Photo Release Form”), signed at the date mentioned above and under signature below, is made between the company I CHOOSE – I AM NOT A VICTIM CORP (the “Company”), represented by Gabriela Humailo Parker as the Founder/CEO and all the Beneficiaries of Molecular Hydrogen (H2) Targeted Methods or the Parent/Legal Guardian if the beneficiary is minor, collectively known as the “Parties.”

Permission to Use Photograph / Photography Consent

I, the undersigned, consent to taking before-and-after photographs of the Molecular Hydrogen (H2) Targeted Methods sessions focused area (face, body) to document the Molecular Hydrogen (H2) Targeted Methods potential results.

I also hereby grant the Company the absolute right and permission to use my photographs in any manner or media, including, but not limited to the following purposes: in the company's portfolio, marketing materials, social media, and/or websites, educational materials, publications, advertising and promotional materials, press releases.

I understand that the Company will not use my name and other identifying information with these photographs without my written consent. If I choose not to consent to the use of photos for these purposes, it will not affect the quality or delivery of the Molecular Hydrogen (H2) Targeted Methods in any way.

Please indicate your consent to the use of photographs. *Yes, I consent to the use of photographs as described above.No, I do not consent to the use of photographs as described above.

Description of Photograph(s) *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Date Taken *

No Compensation

I understand that I will not receive any monetary compensation for the use of my photographs.

Rights Granted

I grant the Company the following rights:

- The right to edit, alter, copy, or distribute the photographs for any lawful purpose.

- The right to use my name in connection with the photographs only with my written consent.

Release and Waiver

I hereby release and discharge the Company, its employees, agents, and representatives from any claims, demands, or causes of action that I may have now or in the future for defamation, invasion of privacy, or violation of the right of publicity or any other right arising out of or relating to the use of photographs.

Signature

By signing below, I acknowledge that I have read and understood this Molecular Hydrogen (H2) Targeted Methods Permission to Use Photo Release Form and agree to the terms and conditions stated above.

The Individual Granting Permission

Beneficiary of the Molecular Hydrogen (H2) Targeted Methods or the Parent/Legal Guardian if the Beneficiary is a minor *

Printed Name *

Signature Date *