Social Media Photo Release Form

Social Media Photo Release Form

Please update your current information below:
Primary Pet Owner*

First NameLast Name
Birth Date of Primary Owner Listed Above*

MonthDayYear
Gender
Phone Number of Primary Pet Owner*
Phone Number for Primary Owner - secondary number will be available laterFormat: (000) 000-0000.
Address of Primary Pet Owner*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of Primary Pet Owner*
example@example.com
YesNo
Authorized Co-Owner

First NameLast Name
Phone Number of Co-Owner
Secondary Number (can be co-owner or preferred Secondary Number - if secondary #, please place same name again in name sectionFormat: (000) 000-0000.
Authorization and Release

I understand that I will not receive any monetary compensation for usage of my pet's photographs on social media platforms if any of the below boxes are checked. Social media platforms include Facebook, Twitter, Instagram, and the company website.
I authorize Highlands Ranch Animal Hospital to take my pet's photographs.I authorize Highlands Ranch Animal Hospital to edit, alter, or copy my pet's photos.I authorize Highlands Ranch Animal Hospital to use photos of my pet that I have emailed, texted, or posted in online reviews for social media platforms.I authorize Highlands Ranch Animal Hospital to use my pet's photos taken by employees on the premises for social media platforms.I decline all of my pet's photos being taken or used for social media platforms. (PLEASE ONLY SELECT IF YOU DO NOT AUTHORIZE ANY OF THE ABOVE)
Email
example@example.com
Signature*

Please Sign or Type Your Signature - Form Incomplete Without Signature
Date Signed*

MonthDayYear
Should be Empty:

Social Media Photo Release Form

Authorization and Release