Photo Consent Release

Photography Release for Minor Child or Children for use by Fertility Centers of New England

I hereby authorize Fertility Centers of New England, to publish photographs or images provided by myself of the child/children listed on this form for use in the Fertility Centers of New England print, online and video-based marketing materials, as well as other Company publications.

I hereby release and hold harmless Fertility Centers of New England from any reasonable expectation of privacy or confidentiality for myself and for the minor child/children listed on this form associated with the images specified. Further, I attest that I am the parent or legal guardian of the child/children listed on this form and that I have full authority to consent and authorize Fertility Centers of New England to use their likenesses and names.

I further acknowledge that participation is voluntary and that neither I, the minor child/children will receive financial compensation of any type associated with the taking or publication of these photographs or participation in Fertility Centers of New England marketing materials or other company publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever.

I hereby release Fertility Centers of New England, its contractors, its employees and any third parties involved in the creation or publication of Fertility Centers of New England publications, from liability for any claims by me or any third party in connection with my participation or the participation of the minor child/children listed on this form.