Media Release Form

I, the undersigned registrant(s), hereby grant permission to Ripple Effect Spiritual Therapies and the Northeast Reiki Retreat, the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used for ANY USE which may include but is not limited to:• Presentations;• Courses;• Online/Internet Videos;• Media;• News (Press);
By submitting this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in any public setting.
There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
This release applies to photographic, audio or video recordings collected as part of the Northeast Reiki Retreat, Pre-Retreat and Retreat sessions only.
By submitting this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material.
*Submission of this form is required to attend the Northeast Reiki Retreat.Thank you!


I agree to the terms of the Ripple Effect Spiritual Therapies and the Northeast Reiki Retreat Media Release Form*

If this release is obtained from a person under the age of 18, then the agreement of that person’s parent or legal guardian is also required.

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