MEDIA RELEASE FORM

BlockLogic Wellness – Course Filming Consent

Course Name: Myofascial Release with a Cork Therapy Block
Course Dates: November 15–16, 2025
Location: MTAM EDUCATION CENTRE, 175 Marion St., Winnipeg, MB R2H 0T3

Dear Participant,
BlockLogic Wellness may be capturing photos and/or video footage during this course for educational and promotional purposes, including (but not limited to) use on our website, social media, and course materials.

Please confirm your consent below: