Moana Beauty Spa - Marketing Photo & Video Consent Release 📸✨
Please provide your details and consent to use your images for marketing purposes.
Client Information
Client Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Date of Birth
*
 -
Month
 -
Day
Year
Date
Date of Consent
*
 -
Month
 -
Day
Year
Date
Consent and Acknowledgements
Include the full consent language exactly as provided in the form body/instructions.
Do you consent to marketing use of your photos/videos?
*
Yes
No
Acknowledgements
*
I am the person shown or legal guardian if applicable
I give permission for photos/videos to be taken
I give permission for online/social media/website/marketing use
I understand this is separate from treatment-record photo consent
I understand results may vary and no guarantee is implied
I understand I can request future removal in writing where reasonably possible
Restrictions and Media Approval
Limitations or restrictions
Sample approved photo
Upload a File
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Signatures
Customer Signature
*
Date Signed
*
 -
Month
 -
Day
Year
Date
Submit
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