RLT Level 1 Training

Dates: Jan – Feb, 2026

Participation and Authorization Agreement to be Videotaped



Please Read Carefully, and Sign Below

In consideration of my being videotaped for my participation in the course RLT Level 1 Training (the “RLI Course”), and for other valuable consideration, receipt of which is hereby acknowledged, I hereby irrevocably and unconditionally covenant, agree and acknowledge the following:

1. Protected Health Information.

a) As a participant in the RLI Course, I understand that during the LIVE course, my being audiovisually recorded is completely optional, and I do not need to speak, ask questions or comment during the course as I may then be audio and visually recorded.

b) If I am recorded, I hereby authorize and grant to Relational Life Institute (“RLI”) and its agents, employees and representatives, the right to audiovisually record, and photograph my participation in the RLI Course, and to include my appearance and participation within the recordings of the RLI Course (the “Recordings”). I understand that I am not required to disclose any health information about myself or any of my family members, but if I do, I authorize RLI to include any and all such health information (the “Health Information”) in the Recordings. I also authorize other registrants of the RLI Course, including other participants and therapists, to observe on a live basis, and future subscribers of the RLI training materials to review the Recordings, including Health Information thereafter via RLI’s website and otherwise. I understand that RLI will receive remuneration from registrants of the RLI Course and subscribers of the RLI training materials.

c) I further authorize RLI to use, disclose, display, publicly perform and modify the Recordings (which shall include my name, image, likeness, appearance, and voice as they appear in the Recordings) for future trainings and marketing purposes in perpetuity throughout the universe, in any manner or media, whether now existing or hereafter developed. I understand and agree that RLI shall have the right to receive remuneration from participants in the future trainings where the Recordings are utilized.
d) I acknowledge and agree that RLI may use and disclose the Recordings as herein contemplated without my further consent, and without the payment of any royalty or other compensation of any kind or nature, to me.
e) I acknowledge and agree that RLI is and shall be the sole and exclusive owner of all right, title, and interest in and to the Recordings, including all copyrights and renewals therein, and any other intellectual property rights therein, in perpetuity throughout the universe. I understand that uses and disclosures already made based upon my original authorization cannot be taken back.
f) I understand that my therapeutic treatment is not conditioned upon my signing this authorization, and that I have the right to refuse to sign this authorization for any reason or no reason.
g) It is understood and agreed that such Recordings may be incorporated into presentations made by Terry Real, which on occasion may be presented by a third party person or entity (each, a “Third Party Host”). With RLI’s prior consent, a Third Party Host may be granted the right to incorporate a recording of Terry Real’s presentation into materials utilized by such Third Party Host for teaching purposes, it being understood and agreed that in such event, the Third Party Host may receive remuneration for the use of Terry Real’s presentation, including the Recordings. Notwithstanding the foregoing, it is specifically understood that no Third Party Host shall have the right to edit the Recordings or use them in any manner other than in the context of Terry Real’s presentation.

Dispute Resolution. I acknowledge that in the event of any breach or alleged breach of the terms hereof by RLI, I shall not have the right to enjoin the use of the Recordings as contemplated hereunder, it being understood that my remedies shall be limited to an action at law to recover damages. Any such action shall be brought in an arbitration in Boston, Massachusetts before a single arbitrator in accordance with the rules of the American Arbitration Association then obtaining. The award of any arbitrator will be final and binding on each of the parties and may be entered as a judgement in any court of competent jurisdiction.

Informed Consent. By signing below, I hereby certify that I am at least 21 years of age, have read and fully understand the above terms and conditions, have had the right and opportunity to consult with counsel of my choosing in connection with this agreement prior to signing, and under no disability or impairment that affects my decision to sign this agreement.

I acknowledge that I have completely read and fully understand this document and consent to participate and be filmed.

Please sign below to consent. Thank you.


Full Name___________________________________________________

Signature___________________________________________ Date__________________________