Consent to be Photographed, Videotaped and/or Audio recorded and Release of Liability

I, the undersigned hereby consent to participate in and to be videotaped and/or audio recorded and /or interviewed as a participant of the emoRelief products and/or services. I understand and agree that emoRelief products and/or services and/or emoRelief representatives, its software and/or hardware, may use techniques based on Neuro-Linguistic Programming, Hypnosis and non coherent low intensity modulated light exposure and other low intensity electromagnetic fields. I understand and agree that emoRelief Program cannot be used as a substitute for, medical advice, diagnosis or treatment. I understand that none of the products and/or services offered by the emoRelief represents or warrants that any of its particular products and/or services is safe, appropriate or effective for me. I hereby release and agree to indemnify and hold harmless emoRelief, wyzEnterprises dba, its parent company ROWIZ, Inc, its affiliates and trustees, officers and employees, agents and representatives from any injury and/or damages sustained as a result of participating in, photographing and/or videotaping and/or audio recording and /or interviewing, including but not limited to, claims for personal injury, property damage, invasion of privacy and/or breach of confidentiality. I have read and understand this consent prior to signing. If minor, signature of parent or guardian:

• NAME(S): ____________________________________________
• ADDRESS: ___________________________________________
• CITY/STATE/ZIP: _____________________________________
• E-MAIL: ______________________________________________
• SIGNATURE: _________________________________________
• DATE: ________________________________________________

emoRelief Release Form