Photo Release & Upload Form
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Email
example@example.com
Instagram Handle - If you would like to be tagged in the photo.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorization, Release, and Consent
Can we use your name?
Complete name
First name
Nickname
Permissions
I authorize and grant GroVia/The Natural Baby Co. to take my photos regarding my experiences with them.
I grant GroVia/The Natural Baby Co. to use my photos on Facebook, Twitter, Instagram, and other social media platform.
I allow GroVia/The Natural Baby Co. to edit, alter, copy, or distribute the photos for social media advertising and marketing.
I agree that the photos belong to GroVia/The Natural Baby Co.
I understand that I will not receive any monetary compensation or have made arrangements prior.
Signature
Clear
Date Signed
-
Month
-
Day
Year
Date
File Upload
Browse Files
Drag and drop files here
Choose a file
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of
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