Video Consent Form

Video Testimonial

Permission to Use Video
Subject: AmpCoil Video Shoot I grant to Health Evolution Tech, Inc (dba AmpCoil), its representatives, contractors and employees, the right to take videos of me and my property in connection OR to use a video that I supply to AmpCoil with the above identified subject. I authorize AmpCoil, its assignees and transferees to copyright, use and publish the same electronically. I agree that AmpCoil may use such videos of me for any lawful purpose, including for example such purposes as publicity, social media, marketing, advertising and Online content. I have read and understand the above:
Signature: *
Signature, parent or guardian:
Signature, parent or guardian:
(if under age 18)