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Client Testimonial Release Form

Practitioner: Nivea Loiselle DE OLIVEIRA

This Release Form relates to my ‘Testimonial’ provided to Nivea Loiselle DE OLIVEIRA.

By signing this Release Form, I hereby consent to the following terms:

1. I agree that Nivea Loiselle DE OLIVEIRA may use, reproduce, distribute and disclose the information in my Testimonial (and/or photographic/videographic likeness) and acknowledge that my Testimonial may be distributed to the public for purposes including but not limited to advertising, promotions and press coverage


2. I understand that I am not entitled to compensation for use of this Testimonial (and/or photographic/videographic likeness) nor input concerning its use.


3. I waive any right to payment for the use of the Testimonial (and/or photographic/videographic likeness) save for use beyond the purpose set out in Paragraph 1 of this Release.


4. I have the right to revoke this Release at any time by providing written notice of my revocation.


5. I understand and approve the disclosure of Testimonial information (and/or

photographic/videographic likeness) and any information contained herein in its

public relation efforts.


6. I waive the right of prior approval and hereby release Nivea Loiselle DE OLIVEIRA from any claims for damages of any kind in the use of this Testimonial or information in this Testimonial (and/or photographic/videographic likeness).


7. La présente décharge est soumise au droit applicable et à la juridiction des tribunaux français.

Data Protection Statement

To comply with the GDPR (General Data Protection Regulation)/applicable Data Protection Regulation, [insert practitioner name] needs explicit permission to process, store and use any of your personal data for marketing purposes.


8.I acknowledge that this Testimonial may contain my personal data and that it will be shared with the public for marketing and other purposes set out in Paragraph 1. I also understand that I am entitled to access this personal data held by [insert practitioner name] and, where appropriate, make requests including for the correction or deletion of my personal data.


By signing this form, I consent to any personal data contained in the Testimonial being shared publicly by [insert practitioner name] and stored in accordance with the GDPR/ applicable Data Protection Regulation.

I can confirm that I have read and understood the Client Testimonial Release Form:

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