NR AESTHETICS LLC — PHOTO & MEDIA RELEASE AGREEMENT
By completing this form and providing an electronic signature, I acknowledge that I have read and understood this agreement and confirm the following:
For purposes of this agreement, “Client” means the individual receiving services from NR Aesthetics LLC, whether an adult or a minor. “Signer” means either the adult Client signing on their own behalf or a parent or legal guardian signing on behalf of a minor Client.
SECTION 1 — AUTHORIZATION
NR Aesthetics LLC ("NR Aesthetics") may request permission to photograph or record the Client in connection with aesthetic treatments, services, or related activities.
If I select "Yes" to media authorization, I authorize NR Aesthetics LLC to use photographs, videos, before-and-after images, and other recordings featuring the Client, strictly for the purposes specifically selected in this form.
This authorization applies exclusively to NR Aesthetics LLC and does not independently authorize any other business or organization to use the Client's images.
If I decline media authorization, I do not grant permission for promotional or educational use of the Client's photographs or videos under this agreement.
SECTION 2 — PERMITTED USES
If media authorization is granted, permission is limited to the categories selected in this form, which may include:
NR Aesthetics' website and online portfolio.
Social media platforms.
Marketing, advertising, and promotional materials.
Professional educational materials.
Uses that are not selected are not authorized by this agreement.
NR Aesthetics will not treat authorization for one category as permission for every category.
SECTION 3 — PRIVACY AND IDENTIFICATION
I understand that I may specify whether the Client's face may be visible and whether the Client's name or social media handle may be published.
NR Aesthetics will respect the selected preferences.
I understand that certain physical features, tattoos, treatment results, or other identifying characteristics may make the Client recognizable even when their name or face is not displayed.
SECTION 4 — EDITING AND PUBLICATION
I authorize reasonable cropping, resizing, color correction, and formatting of approved media, provided these modifications do not intentionally misrepresent the Client's appearance, treatments, or treatment outcomes.
I understand that content published online may be saved, shared, or reproduced by third parties outside NR Aesthetics' control.
Any editing or publication remains subject to the permissions selected in this form.
SECTION 5 — COMPENSATION
I understand that neither the Client nor the Signer will receive payment or other compensation for authorized media use unless otherwise agreed in writing.
SECTION 6 — WITHDRAWAL OF CONSENT
I may withdraw this authorization by submitting a written request to NR Aesthetics using the contact information published on aestheticsbynr.com.
Withdrawal applies to future uses after the request has been received and processed.
I understand that withdrawal may not require removal of previously distributed printed materials, third-party copies, or cached online content, subject to applicable law.
Where a parent or legal guardian has signed on behalf of a minor Client, withdrawal requests will be handled according to applicable law and the authority of the person making the request.
SECTION 7 — VOLUNTARY PARTICIPATION
I understand that authorizing photographs or videos for promotional or educational use is voluntary.
Declining media authorization will not affect the Client's eligibility for services or treatment at NR Aesthetics.
This release does not replace separate treatment consent, clinical photography consent, or any privacy or HIPAA authorization required by applicable law.
SECTION 8 — ELECTRONIC ACKNOWLEDGMENT
By signing electronically, I confirm that I have read and understood this agreement; that my selections accurately reflect the media permissions I grant or decline; that I understand authorization is voluntary; and that I intend my electronic signature to serve as my acknowledgment and authorization or refusal.
I further confirm that I am either the adult Client identified in this form or a parent or legal guardian authorized to sign for the identified minor Client.
I understand that my electronic signature and signing acknowledgment will be recorded with the completed form.
SECTION 9 — MINOR CLIENTS: PARENT OR LEGAL GUARDIAN AUTHORIZATION
This section applies when the Client is under 18 years of age.
If the Client identified in this form is a minor, I confirm that I am the minor Client's parent or legal guardian and have the legal authority to make the media authorization decisions recorded in this agreement on the minor's behalf.
I understand that the minor Client's full name and date of birth are provided for identification purposes and that I, as the identified parent or legal guardian, must personally provide the electronic signature.
The minor Client is not the Signer of this agreement.
My authorization or refusal applies exclusively to NR Aesthetics LLC and is limited to the media uses, facial visibility, and identification preferences selected in this form.
If I decline media authorization, I do not grant NR Aesthetics LLC permission for promotional or educational use of the minor Client's photographs or videos under this agreement.
I understand that media authorization is voluntary and that declining authorization will not affect the minor Client's eligibility for services or treatment.
I further acknowledge that my relationship to the minor and my legal signing authority are self-attested through this form and are not independently verified by the electronic signing system.
Any withdrawal of consent will be handled according to Section 6 and applicable law.
This authorization does not replace separate treatment consent, clinical photography consent, or any authorization required for the use or disclosure of protected health information under applicable law.
