A Division of Royal Wealth Heritage LLC · Form 5 of 7

Photo & Media Release

Grant or decline permission for use of your student's image in marketing and educational materials.

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Notice: Royal Wealth Heritage LLC provides educational support services only and does not provide medical treatment, therapy, counseling, occupational therapy, speech therapy, ABA therapy, or psychological services.

Royal Wealth Heritage LLC provides educational support services only and does not provide medical treatment, therapy, counseling, occupational therapy, speech therapy, ABA therapy, or psychological services.

Purpose

Royal Wealth Heritage LLC may document educational activities through photographs or video recordings for program records, parent communication, and promotional purposes.

Consent Options

You may grant or decline permission below. Declining permission will not affect your student's eligibility for educational services.

If granted, images may be used on the company website, social media, brochures, and other marketing materials without compensation. Names will not be published without separate written consent unless you indicate otherwise.

You may revoke this consent at any time in writing by contacting the company. Revocation applies to future use only.

Signature Information

Student Name *

Parent/Guardian Name *

Parent/Guardian Email *

Media Consent *

Name Publication (optional)

Date Signed *

I confirm the media consent selection below and that I am the parent or legal guardian authorized to provide this consent.

Continue to Attendance & Cancellation Agreement