If awarded, by accepting the Feeding Matters Family Assistance Program funds: 

• I agree to spend all money awarded to me by Feeding Matters Family Assistance Program on items, services, or medical treatments that directly relate to caring for a child with pediatric feeding disorder (PFD) or feeding difficulties within one year of receiving funds. 
  
  
• I understand that if Feeding Matters determines, in its sole discretion, that Family Assistance Program funds have been used to cover costs not directly related to caring for a child with PFD, then Feeding Matters retains the right to seek repayment of such funds from me.
  
  
• I agree to share our PFD story on Feeding Matters' website, which may be shared on social media. View the PFD Story submission form to see what is involved. Sharing your story raises awareness of PFD and feeding difficulties and is encouraged for all applicants.

I grant permission to Feeding Matters and its employees to use photographs taken of

and me and submitted by me in connection with my application for assistance. I also grant permission for Feeding Matters to quote my words from any written material that I have submitted. These images and/or quotes may be used on the Feeding Matters and other websites, including social media sites, in promotional materials, educational materials, documentaries (e.g., video documentaries), public service announcements, grant applications, digital or print newsletters, Family Assistance Program materials, derivative works, or for similar purposes without compensation to me.

I grant permission to Feeding Matters and its employees to use photographs on the Internet. I also understand and agree that I may be identified by name and/or title in printed, Internet or broadcast information that might accompany the photographs of me. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, and any reproductions thereof are and shall remain the property of Feeding Matters. I hereby agree to release, defend, and hold harmless Feeding Matters and its employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper, via electronic media, or on Web sites, from any claim, damages, or liability arising from or related to the use of my words, photographs, including but not limited to any misuse, distortion, blurring, alteration, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction, or production of the finished product, its publication, or distribution.

I certify that I have read this release before signing below and fully understanding its contents, meaning, and impact. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

I affirm that information in this application and uploaded documents is true and accurate according to my knowledge.