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I FURTHER CERTIFY THAT THE FOREGOING STATEMENTS AND REPRESENTATIONS ARE BEING MADE BY ME KNOWINGLY FREELY AND VOLUNTAIRILY AND I UNDERSTAND THAT HEALING STRIDES OF VA IS EXPRESSLY RELYING UPON THE FOREGOING STATEMENTS AND REPRESENTATIONS IN PERMITTING ME TO PARTICIPATE IN. TO SECURE MEDICAL TREATMENT INCLUCING X-RAY SURGERY HOSPILIZATION AND MEDICATION. SIGNATUREDATE PARENT/GUARDIANDATE PHOTO RELEASE Must Initial I CONSENT TO AND AUTHORIZE THE USE AND REPRODUCTION BY HEALING STRIDES OF VA OF...

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