Contact Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.As a participant in the event "Human Canvas Painting at Chashama Gala" taking place on June 10th 2023, I hereby irrevocably consent to and authorize the use and reproduction by Andy Golub (Andy) of any and all photographs, video and audio footage that Andy or anyone authorized by Andy has taken of me or of my art for any purpose whatsoever at no compensation to me. All such photographs, video and audio footage recorded on the day of Human Canvas Painting at Chashama Gala, shall constitute the property, solely and completely, of Andy. I certify that I am over 18 years of age. I participate willingly and voluntarily and assume full responsibility for any personal injury occurring as a result of any accident that may occur. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.I agreeI do not agreeDate *Name *FirstLastEmail *Submit