Consent to be Photographed, Videotaped and/or Audio recorded and Release of Liability

I, the undersigned hereby consent to participate in and to be videotaped and/or audio recorded and /or interviewed as a participant of the artifactRelief products and/or services. I understand and agree that artifactRelief products and/or services and/or artifactRelief representatives, its software and/or hardware, may use techniques based on Neuro-Linguistic Programming, Hypnosis and non coherent low intensity modulated light exposure and other low intensity electromagnetic fields. I understand and agree that artifactRelief Program cannot be used as a substitute for, medical advice, diagnosis or treatment. I understand that none of the products and/or services offered by the artifactRelief represents or warrants that any of its particular products and/or services is safe, appropriate or effective for me. I hereby release and agree to indemnify and hold harmless artifactRelief, wyzEnterprises dba, its parent company, its affiliates and trustees, officers and employees, agents and representatives from any injury and/or damages sustained as a result of participating in, photographing and/or videotaping and/or audio recording and /or interviewing, including but not limited to, claims for personal injury, property damage, invasion of privacy and/or breach of confidentiality. I have read and understand this consent prior to signing. If minor, signature of parent or guardian:

• NAME(S): ____________________________________________
• ADDRESS: ___________________________________________
• CITY/STATE/ZIP: _____________________________________
• E-MAIL: ______________________________________________
• SIGNATURE: _________________________________________
• DATE: ________________________________________________

artifactRelief Release Form