Baby Photo Form





I, , legal parent/guardian of , give Agassiz Medical Centre permission to post my child's photo on their website agassizmedicalcentre.com. I understand that I am providing authorization for this picture to be posted until I notify Agassiz Medical Centre to remove such photo.

I understand that only my baby's first name, date of birth and the physician from Agassiz Medical Centre who delivered him/her will be displayed.