Photo Release Form Permission to Use Photograph(s) and videos taken during
treatment. I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees,
providers and clients the right to take photographs of me and my
property in connection with the above-identified subject. I authorize
Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use
and publish the same in print and/or electronically. I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such
photographs of me with or without my name and for any lawful
purpose, including for example such purposes as publicity,
illustration, advertising, and Web content. I have read and understand the above.
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