Lumisque Inc. | CO2Lift® | CO2Lift® V

This Consent (“Agreement”) is between the undersigned individual (“Participant”) and Lumisque Inc., including its affiliates, brands (including CO2Lift® and CO2Lift® V), partners, licensees, and authorized representatives (“Company”).

1. Permission to Use Images & Media

I grant the Company permission to photograph, film, record, and use my likeness, image, voice, body, treatment area, and before-and-after results (“Content”).

I understand the Company may use this Content worldwide, in perpetuity, without compensation, in any format or platform now known or later developed.

2. How Content May Be Used

Content may be used for lawful business purposes including:

• Medical and professional education
• Clinical presentations and conferences
• Internal and external training
• Advertising and marketing (digital and print)
• Social media, websites, email, and e-commerce
• Press, media, and editorial features
• Trade shows, sales materials, and packaging inserts

Use may occur on Company platforms or authorized third-party platforms.

3. Medical Context & Results

I understand:

• Before-and-after images reflect my individual results only.
• Results vary and are not guaranteed.
• The Company may reference general treatment type or timing, but will not disclose protected health information beyond what appears in the image itself.

4. Ownership & No Compensation

All Content becomes the property of Lumisque Inc.

I waive the right to review or approve final materials and understand no payment, royalty, or credit is owed unless separately agreed in writing.

5. Release of Liability

I release Lumisque Inc. and its representatives from claims arising from authorized use of the Content, including privacy or publicity claims.

I understand that once published, the Company cannot control unauthorized third-party sharing.

6. Identification Preference

Please select one:

I consent to fully identifiable use
I request reasonable efforts to obscure identifying features

Complete anonymity cannot be guaranteed.

7. Revocation

Consent may be revoked in writing at any time.
Revocation applies only to future use and does not affect Content already created, published, or distributed.

8. Privacy Notice (U.S. • EU • UK • Canada)

If I reside in the EU/UK, my consent is provided under GDPR Article 6(1)(a).
If I reside in Canada, consent is provided under PIPEDA and applicable provincial laws.

I understand::

• My data may be stored or processed in the United States or other countries.
• I may request access or correction of personal data where legally permitted.
• Removal may not be possible once materials are published or archived.

9. Representations

I confirm:

• I am 18 years or older and legally able to consent.
• If under 18, a parent/guardian has signed below.
• Participation is voluntary

This Agreement is governed by Florida law.

Participant Information

Please sign below using your mouse:

Date:  

IF UNDER 18

Parent/Guardian Signature:

Date:  

IMAGE UPLOAD

Hi-Res images only. Please upload 2 images minimum, 6 images maximum. Over 6 images, please contact us.