Note (An answer of yes to the above question does not necessarily disqualify you for entrance into a program at Career Health Services Academy, LLC..)

I, the undersigned, have read and understand this agreement. It is further understood and agreed that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement on the student and the School Official. I also understand that if I default upon this agreement, I will be responsible for payment of any collection fees or attorney fees incurred by Career Health Services Academy, LLC.

I, the undersigned, do hereby consent and agree that Career Health Services Academy, LLC, its employee, or agents have the rights to take photographs, videotape, or digital recordings of me and to use these in all media, now or hereafter known, and exclusively for the purpose of pictures. I further consent that my name and identify may be revealed therein or by descriptive text or commentary. I do herby release to Career Health Services Academy, LLC its agents, and employees all rights to exhibit this work in print and electronic form publicity or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

I also understand that Career Health Services Academy, LLC is not responsible for any expense or liability incurred because of my participation in this recording, including medical expensed due to any sickness or injury incurred as a result. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

My electronic signature below signifies that I have read and understand all aspects of this agreement and do recognize my legal responsibilities regarding this contract.