Photo Consent Form

This photo consent form requests your permission for your child’s photo/image and personally identifiable information to be published on the Bohring-Opitz Syndrome Foundation, Inc. website, social media accounts, and products . As you are aware, there are potential dangers associated with the posting of personally identifiable information on a web site since global access to the Internet does not allow us to control who may access such information. These dangers have always existed; however, we want to raise awareness for Bohring-Opitz Syndrome and in order to do this we need your permission. The law requires that we ask for your permission to use information about your child. Pursuant to law, we will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information that could possibly be posted on website, social media, or products may include child's names and photo/image . If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to Bohring-Opitz Syndrome Foundation, Inc. and such rescission will take effect upon receipt by foundation.

Child's Name

First Name

Last Name

Child's Date of Birth

YYYY

Parent/ Guardian

First Name

Last Name

Parent/Guardian

First Name

Last Name

Relationship to Child

Electronic Signature of Parent/Guardian

I agree to the Bohring-Opitz Syndrome Foundation using the image(s) and/or story and give hereby the BOS Foundation permission to publish, use and republish the attached material.