Date

MM

DD

YYYY

Name of Caregiver *

First Name

Last Name

Name of Care Recipient *

First Name

Last Name

Release *

I irrevocably grant to Caregiver Connections, its representatives and employees permission to use and own the copyright to any photographs, video, or other likeness of me, the caregiver, and my loved one, the care recipient, while participating in Caregiver Connections programs and activities. I waive any rights, compensation or ownership interest thereto. I agree that Caregiver Connections may use such photographs of me with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and web content. I hereby agree that I will not bring or consent to others bringing any claim or action against Caregiver Connections in regards to the Property (photographs) and hereby release Caregiver Connections its directors, officers, successors and assigns from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I may hereafter have against Caregiver Connections in connection with the Property. I give permission for:

For myself, the caregiver

For my loved one, the care recipient

Electronic Signature Acknowlegment *

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.

I accept