Image Release Form - Purple DInosaur

PURPLE DINOSAUR LTD
Image Release Form

www.purpledinosaur.co.uk

Permission to Use Image / Video

I hereby grant permission to Purple Dinosaur Ltd and their client, agents, licensees, and assigns to use photographs and/or video footage of me, in which I may appear, for the following purposes:
- Marketing, promotional, and advertising use by the client for whom the material was captured
- Use across any media channels, including but not limited to print, website, social media, and digital marketing
Additionally, I grant permission to Purple Dinosaur Ltd to use such images and/or video for their own purposes, including but not limited to:
- Social media promotion Marketing and promotional material for Purple Dinosaur Ltd
The images and video may be edited or modified as required I will not be entitled to any payment, royalty, or other compensation for the use of these

The rights granted are perpetual, worldwide, and may not be revoked once the material is in use.
Full Name

First NameLast Name
Company / Clinic Name
Age Verification
Date of Birth of Minor

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Full Name of Parent/Guardian

First NameLast Name
Relation to Minor
Email Address
example@example.com
Phone Number

Area CodePhone Number
Signature
Data Privacy Your personal data will be processed solely for the purpose of documenting consent and will not be shared externally beyond what is required for the use of the images/videos as described above. For full details on how we handle personal data, please refer to our Privacy Policy at www.purpledinosaur.co.uk/privacy-policy.
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PURPLE DINOSAUR LTDImage Release Form

www.purpledinosaur.co.uk

Permission to Use Image / Video

PURPLE DINOSAUR LTD
Image Release Form