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(480) 892-7403

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Call (480) 892-7403

Policies

Policies
Client's Name:
Client's Name:
Gender:

Parent(s)/Guardian

Parent(s)/Guardian's Name:
Parent(s)/Guardian's Name:

Media Release

It is the policy of Anasazi Foundation that recording or filming, or photographing of any client during care, treatment, and service will require the Client’s written consent to ensure the Client’s privacy and confidentiality.  The recording remains in the organization's possession and is not used for any purpose until consent is obtained (see below).  The Client and/or family has the right to request cessation of recording, filming, or photographing.  The Client and/or family has the right to rescind consent for use up until a reasonable time established by Anasazi before the recording or film is used.

 

Full Release

I hereby give permission to Anasazi Foundation to video record, photograph, and/or audio record me and my comments in a taped presentation to be recorded and shown for educational, marketing, and/or public relations purposes including, but not limited to, public display on the Anasazi Internet website(s).  I understand that under no condition will my name be released in affiliation with this presentation without my written permission and further know that if I am a minor, my legal guardian must also approve.

Initial and Date Parent/Guardian
Initial and Date Parent/Guardian
Initial and Date Client/Student
Limited Release

I hereby give permission to Anasazi Foundation to video record, photograph, and/or audio record me and my comments in a taped presentation to be recorded and presented on a private, password-protected area of the Anasazi Internet website(s).  I understand that Anasazi will not disclose the password or access codes to this area of the website to anyone without my written permission and further know that if I am a minor, my legal guardian must also approve. The purpose of this, or of the website, is to allow parents and/or other authorized persons to access multimedia presentations of the Client while at Anasazi.

Initial and Date Parent/Guardian
Initial and Date Parent/Guardian
Initial and Date Client/Student