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Purpose of Consent: By signing this form (the “Release”), you are authorizing Pineapple Academy, Inc. (the “Company”) to use and disclose your written and/or video testimonial (the “Testimonial”) in its marketing and public relations efforts and acknowledge that the Testimonial may be distributed to the media, other individuals and entities that may be involved in the Company’s marketing and public relations efforts.

Right to Revoke: You have the right to revoke this Release at any time by giving us written notice of your revocation and submitting it to the Company at the address listed below. Please understand that revocation of this Release will not affect any action or use the Company took in reliance on this Release before receiving your revocation.

Consent and Release of Information: I authorize the Company to copy, exhibit, publish, distribute or otherwise use and disclose my Testimonial and any information in it for purposes of publicizing its services and products, for any other marketing and public relations efforts or for any other lawful purpose. The Testimonial may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I further authorize the Company to use my name, image, likeness, voice, and brief biographical information in conjunction with the Testimonial.

I agree that I will make no monetary or other claim against the Company for the use of the Testimonial. I waive any right to inspect or approve the finished product, including written copy or edited video, wherein my name, image, likeness, voice, biographical information and/or Testimonial appears.

I hereby hold harmless and release the Company from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Company Contact Information:
Pineapple Academy, Inc.
605 SW US Highway 40, #292
Blue Springs, MO 64014

By completing the form and clicking submit, I acknowledge that I have read this Customer Testimonial Consent & Release, understand it and agree to it.


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