Social Media Photo Release Form
Name
*
First Name
Last Name
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorization and Release
What is your preference regarding the use of your pet/horse/livestock's name?
I consent to the use of their name.
I consent to the use of their photographs anonymously.
Please check the boxes regarding your preference.
I authorize Massie Veterinary Services to take photographs of my animal/s.
I authorize Massie Veterinary Services to use my photographs of my animal/s on Facebook, Twitter, Instagram, and other social media platforms.
I authorize Massie Veterinary Services to edit, alter, copy, or distribute the photos for social media advertising and marketing.
I agree that the photos all intellectual property rights of the photos belong to Massie Veterinary Services.
I agree that I will not receive any monetary compensation for usage of photographs of my animal in social media platforms.
Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: