Social Media Photo Release Form

Pixpreneur Media Release Form
Name*

First NameLast Name
Birth Date

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorization and Release
Please check all the boxes that apply below.

I consent to the use of my complete name.I consent to the use of my Social Media name.
Please check all the boxes below*

I authorize Pixpreneur to take my photographs.I authorize Pixpreneur to use my photos on Facebook, Twitter, Instagram, and other social media platforms.I authorize Pixpreneur to edit, alter, copy, or distribute the photos for social media advertising and marketing.I agree that the photos and all intellectual property rights of the photos belong to Pixpreneur.I agree that I will not receive any monetary compensation for usage of my photographs on social media platforms.This is a collaborative work and there is no compensation.All images produced by Pixpreneur will come with 100% usage rights WITH FULL ATTRIBUTION of Pixpreneur at all times. Usage of any image without attribution of Pixpreneur will be a violation.
Signature*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty:

Pixpreneur Media Release Form