Just KHI LLC

Photo, Video & Testimonial Consent Form

Thank you for being part of the Just KHI experience.
Please complete this form to grant your permission.

We use storytelling, movement, and interactive learning to create meaningful mental health and wellness outcomes. To help us document and share the impact of this work, please complete the consent form below. Your participation and trust are deeply valued by the Just KHI team.

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Thank you for submitting your media consent. Your information has been securely received and recorded.

We value your privacy and ensure your data is handled safely and confidentially.

1 Event Details (optional)

2 Consent Statement

I, the undersigned parent/legal guardian, hereby grant Just KHI LLC and its representatives permission to:

⚠  Please select at least one consent option above.

3 I Understand That:

  • No compensation will be provided in exchange for the use of photos, videos, or testimonials.
  • My child’s last name will not be used without additional written permission.
  • I may revoke this consent in writing to [email protected], but materials already published cannot be recalled.
  • Just KHI LLC is not responsible for third-party use once content is publicly shared.
  • All media will be used respectfully and in alignment with the organization’s mission.

4 Personal Information

5 Signature

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For Just KHI Use Only

By submitting, you confirm you have read and agree to all terms above.