PHOTO AND SOCIAL MEDIA RELEASE FORM
Please indicate your consent for the use of photos and videos of your child for the purposes listed below.
Photo/Video - Training
Yes
No
Photo/Video - Marketing
Yes
No
Photo/Video – Website/Social Media
Yes
No
Photo/Video - Clinic
Yes
No
Printed Name of Parent/Guardian
Signature of Parent/Guardian
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Printed Name of Child
Submit
Submit
Should be Empty: