Social Media Photo & Video Release Form
Name
*
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorization and Release
Do you consent to the use of your photographs and/or videos for training, marketing and social media use? I will NOT use names at all.
I consent to the use of my photographs and/or videos for use online and in marketing materials.
I DO NOT consent for you to use my photographs or videos other than for services and ongoing care. (Before and After pictures will only be used for plan of care and evaluation of treatments and services provided).
Please check the boxes regarding your preference.
I authorize RN Mobile Skincare to take my photographs and record video of treatments provided.
I authorize RN Mobile Skincare to use my photos/videos on Facebook, TikTok, Twitter, Instagram, and other social media platforms.
I authorize RN Mobile Skincare to edit, alter, copy, or distribute the photos/videos for social media advertising and marketing.
I agree that the photos/videos all intellectual property rights of the photos belong to RN Mobile Skincare. I may request copies of my own photos/videos at any time.
I agree that I will not receive any monetary compensation for usage of my photographs/videos in social media platforms or in marketing/training materials.
Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: