Social Media Photo Release Form

Social Media Photo Release Form
Name*

First NameLast Name
Birth Date*

MonthDayYear
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorization and Release
What is your preference regarding the use of your name?(Pick One)*

I consent to the use of my complete name. (Includes All Variations Below)I consent to the use of my first name only. (Includes All Variations Below)I consent to the use of my nickname. (Includes Variation Below)I consent to the use of my photographs anonymously.
Please check the following boxes to confirm consent for the use of Photos:*

I authorize GLO with Kelsey to take my photographs.I authorize GLO with Kelsey to use my photos on Facebook, Twitter, Instagram, and other social media platforms.I authorize GLO with Kelsey to edit, alter, copy, or distribute the photos for social media advertising and marketing.I agree that all intellectual property rights of the photos belong to GLO with Kelsey.I agree that I will not receive any monetary compensation for usage of my photographs in social media platforms.
Date Signed*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Authorization and Release