SOCIAL MEDIA PHOTOGRAPHY & VIDEO RELEASE FORM

SOCIAL MEDIA PHOTOGRAPHY & VIDEO RELEASE FORM
CLIENT INFORMATION
Name:

First NameLast Name
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Referral (if applicable):
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
AUTHORIZE & RELEASE
What is your preference regarding the use of your name?
Please check the boxes regarding your preferences:
I hereby release Glow Haus and their legal representatives and assigns from all claims and liability relating to said photographs and or videos.

I hereby warrant that I am of full age of majority and have the right to contract in my own name. I have read the above authorization, release, and agreement, prior to its execution, and I am fully familiar with the contents of the document.
PRINTED NAME

First NameLast Name
SIGNATURE
DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: