By pressing SUBMIT  you agree to the rules of our Public Relations Patient Consent Form:

I grant permission for Community Sports and Therapy may use my name in any publicity (i.e. Facebook, Twitter, CST website, etc.) accompanying any photograph and/or videotape which has been taken, or written endorsement or communication from me and relinquish any claims of rights of these and the use of my name with them.

I relinquish any claims to any photograph and/or video taken and understand that they are the possession of Community Sports and Therapy and/or an appointed agent. I understand that I will receive no compensation for any picture/videotape taken or written endorsement used.