Media Release Form

1

Media Release Form* This field is required.I hereby give Red Oak Animal Hospital permission to take photographs and videos of my pet for the purpose of posting on Red Oak Animal Hospital’s social media including Facebook, Instagram, our website and potentially other social media outlets. I hereby release and discharge Red Oak Animal Hospital from any and all claims arising out of use of the photos.

Initials

2

Red Oak Animal Hospital has my permission to use: (Select one)* This field is required.

Only my pet’s name(s)

My pet’s name(s) and my last name

My pet’s name(s) and my first and last name

3

In signing this consent, I give authorization to use my name and my pet’s name as printed below* This field is required.

Pet’s printed name

Owner’s printed name

Email

4

Owner’s Signature* This field is required.

Clear

5

Date* This field is required.

Date