I give to Heal Movement Corp, and its designees and agents, unlimited permission to photograph, videotape, and record me and my residence/property; and, for Heal Movement Corp and its licensees and assignees, permission to use, publish and republish in any form or media for any purpose, information about me, statements made by me, and reproduction of my likeness, my voice, and my residence/property, with or without identification of me by name. 
If a child’s image is used with mine or separately, and I am the parent or guardian of that child, I sign this on behalf of myself and the child.