Photo and Video Release Form
Client Information
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pet Details
Pet Name
First Name
Last Name
Species
Canine
Feline
Rabbit
Other
Back
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Authorization and Release Agreement
Please read and check the following:
I allow {companyName} to take or capture photos and videos of myself and/or my pet.
I understand that all photos and videos that will be taken in this activity are copyrighted by {companyName}.
I hereby authorize and agree to edit, alter, copy, exhibit, publish or distribute this photo for for purposes of publicizing your programs or for any other lawful purpose
I waive any right to royalties or other compensation arising or related to the use to the photograph and/or video.
I authorize {companyName} to distribute and reproduce the materials for the following purposes: Portfolio showcase, advertising, marketing, branding, educational, digital promotions, internet videos, online courses, media, other commercial or non-commercial purposes
I grant {companyName} to use my photos and videos on Youtube, Vimeo, Facebook, Twitter, Instagram, and other social media platform.
I do not permit {companyName} to use these materials that can harm my reputation or others.
I release {companyName} from all liability and obligations from any claim for injury, illnesses, claims, or demands.
I/We, the undersigned, hereby agreed that we have read this agreement and bounded by it.
Client Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: