Include your educational background, relevant licenses, and specialized training you’ve taken. Showcase continuing education (evidence-based treatment modalities) and mention professional memberships.
Month / Year
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Photo / Video Permissions

I hereby grant DELAWARE GUIDANCE SERVICES, its directors, officers, employees, agents, and designees non-revocable permission to capture/use my image and information collected in this form in video, recordings, or any other media. I acknowledge that DELAWARE GUIDANCE SERVICES will own such images and further grant DELAWARE GUIDANCE SERVICES permission to copyright, display, publish, distribute, use, modify, print and reprint such images in any manner whatsoever related to DELAWARE GUIDANCE SERVICES business, including without limitation, publications, advertisements, brochures, social media, website images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the image by DELAWARE GUIDANCE SERVICES prior to its use. I forever release and hold DELAWARE GUIDANCE SERVICES harmless from any and all liability arising out of the use of the images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the images, including without limitation, claims for invasion of privacy rights or publicity. I hereby warrant that I am eighteen (18) years old or more and competent to make this decision and choose an option below.