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My Testimony

This is Release Form relates to my ‘Testimonial’ provided to Barb Smith Varclova - Your Steps Counselling (Practicioner).

By submitting this Release Form, I hereby consent to the following terms:

1.    I agree that Practitioner may use, reproduce, distribute and disclose the information in my Testimonial (and/or photographic/videographic likeness) and acknowledge that my Testimonial may be distributed to the public for purposes including but not limited to advertising, promotions and press coverage with using identification I provided as Published Name.
2.    I understand that I am not entitled to compensation for use of this Testimonial (and/or photographic/videographic likeness) nor input concerning its use.
3.    I waive any right to payment for the use of the Testimonial (and/or photographic/ videographic likeness) save for use beyond the purpose set out in Paragraph 1 of this Release.
4.    I have the right to revoke this Release at any time by providing written notice of my revocation.
5.    I understand and approve the disclosure of Testimonial information (and/or photographic/videographic likeness) and any information contained herein in its public relation efforts.
6.    I waive the right of prior approval and hereby release Practicioner from any claims for damages of any kind in the use of this Testimonial or information in this Testimonial (and/or photographic/videographic likeness).
7.    This Release is subject to the governing law and jurisdiction of the United Kingdom and Scottish courts.

Data Protection Statement

To comply with the GDPR (General Data Protection Regulation, Practitioner needs explicit permission to process, store and use any of your personal data for marketing purposes.


⦁    I acknowledge that this Testimonial may contain my personal data, and that it will be shared with the public for marketing and other purposes set out in Paragraph 1 only Published Name, Country, Review Title and Review of Services. I also understand that I am entitled to access this personal data held by Practitioner and, where appropriate, make requests including for the correction or deletion of my personal data. By submitting this form, I consent to any personal data contained in the Testimonial (Review of service) being shared publicly by Practitioner and stored in accordance with the GDPR Regulation.

Thank you for your testimonial!

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