ISEW Media Consent Form
Please indicate your permissions for the use of photos and video of your horse. Your choices do not affect service eligibility. Complete all sections and sign to authorize.
HORSE NAME
Choose Your Permission Level
*
CASE RECORDS ONLY - I allow photos/video to be stored in the horse’s private client record for documentation and comparison. They will not be used publicly without additional permission.
EDUCATION - I allow de-identified photos/video to be used in practitioner training, client education, courses, presentations, or professional case discussion. The horse/owner will not be intentionally identified unless separately approved.
MARKETING & SOCIAL MEDIA - I allow photos/video to be used in websites, social media, brochures, advertising, presentations, and other promotional materials.
NAME / HORSE IDENTIFICATION MAY BE USED - In addition to the permissions selected above, I allow the horse’s name, barn/team name, and/or my name to be identified as follows:
NO PHOTO / VIDEO PERMISSION - Do not capture or use photos/video except when required for an immediate safety or service record and permitted by applicable law.
Name / Horse Identification Details
Optional Restrictions (for example: no owner name, no barn name, no face/people, no location tagging, no paid advertising)
PRINTED NAME
*
First Name
Last Name
EMAIL / PHONE
*
OWNER / AUTHORIZED AGENT SIGNATURE
*
DATE
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: