I hereby grant permission and consent to Backlight Productions to photograph, record, film and/or videotape myself, or the individual whom I am the Conservator, in the classroom or other setting for business, marketing, informational or instructive purposes and to edit, portray, and exhibit the photograph, film/videotape produced thereby in part or in whole, for cablecast and/or broadcast, Web media or other public viewing. I understand that there will be no financial or other remuneration for the use of any photograph, film and/or videotape and hereby release Backlight Productions and waive any and all causes of action of every kind and nature including any claim for breach of confidentiality, privacy, or otherwise arising out of or occasioned by the activities consented to hereby.

The consent and permission hereby granted may be withdrawn if written notice is delivered to Backlight Productions, 1710 General George Patton Dr. #107 Brentwood, TN. 37027. I understand that revocation will not affect any photograph, film and/or videotape that has been produced before the written notice is received.