Photo Permission Form Name of Minor Child First Last I give consent for Spinnaker Pediatric Dentistry and all employees and/or agents of Spinnaker Pediatric Dentistry to take and/or display photograph(s) of the face and teeth/smile of my minor child. The photograph(s) will be used for educational and/or advertising purposes by Spinnaker Pediatric Dentistry and may be displayed within our office and/or on the dental office’s webpage, www.spinpedo.com. The doctors and office staff will protect the patient’s personal data, such as name, age and date of birth, from being displayed. And I understand that I, or my minor child (under age 18), will not receive compensation for the use of these photograph(s). Name of Parent or GuardianEmailThis field is for validation purposes and should be left unchanged.