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Release executed on date By Releasor print name Signature of Releasor Parent and/or Legal Guardian Children s name s if applicable. Media irrespective of the form in which they are produced and used. 3. MY RIGHTS I the Releasor may revoke this authorization at any time. 1. CONSENT TO PHOTOGRAPH AUTHORIZATION FOR USE AND DISCLOSURE I the undersigned the Releasor being of lawful age personally and on behalf of any children listed below hereby consent and authorize Martha s Village Kitchen...
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