Pet Model Release Form

Please read the following information carefully, and complete the form below:

I hereby confer on Rhinebeck Animal Hospital the absolute and irrevocable right and permission with respect to the photographs that Rhinebeck Animal Hospital has taken of my pet in which he/she may be included with others:

To copyright the same in Rhinebeck Animal Hospital name or any other name that they may select;
To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter for illustration, promotion, advertising and trade, including, but not limited to, advertising related to Rhinebeck Animal Hospital and;

I hereby release and discharge Rhinebeck Animal Hospital from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of Rhinebeck Animal Hospital.

I have read the foregoing and fully understand the contents hereof and state that I agree to this release of my own free will and without expectation of financial compensation. I represent that I am the owner of the below-named model.

Pet's Name(s) *

Owner's Name(s) *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Email

example@example.com

Signature

Clear

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