Sandra Lee Tyrrell, ATR-BC, LPC
Registered and Board Certified Art Therapist Licensed Professional Counselor
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Contract for Using Child Client Art
CONTRACT BETWEEN art therapist's name 1, artist's name ,agree to allow art therapist's name and artidclient's name
to use andlor display andfor photograph my artwork for the following purpose(s):
o Publication in a professional journal
a Presentation at professional conferences
Consultation with other mental health professionals (includes supervision) Educational purposes I wish to remain anonymous Signed artist's signature Signed parenuguardian's signature ,agree to the following conditions in connection with my use artist's name of artwork by art therapist's name I agree to safeguard your artwork to the best of my ability and to notify you immediately of any loss or damage while your art is in my possession. I agree to return your artwork if you decide to withdraw your consent. I agree to safeguard your confidentiality. Date yes no Date
1,
I agree to re-contact both artist and parentslguardian to renegotiate the use of the artwork for a public showing,
should the opportunity arise to exhibit the artwork. Signed Date