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If different from above, please provide the contact information for the adult who will be supervising the child at the football game.
I hereby authorize Archboldl Medical Center, together with its employees, agents and contractors, to use images of my child for the marketing purposes as noted below:
Purpose(s) of the Use or Disclosure:
Marketing for Archbold Medical Center and Live Better to try to encourage the use of Archbold Medical Center services and treatment facilities and products by the genreal public and/or community.