Social Media Photo & Video Release Form

Social Media Photo & Video Release Form
Name*

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Authorization and Release
What is your preference regarding the use of your name?

I consent to the use of my complete name.I consent to the use of my first name only.I consent to the use of my nicknameI consent to the use of my photographs anonymously.
Please check the boxes regarding your preference.

I authorize Get Up & Dance Fitness to take photographs & videos.I authorize Get Up & Dance Fitness to use photos & videos on Facebook, Twitter, Instagram, and other social media platforms.I authorize Get Up & Dance Fitness to edit, alter, copy, or distribute the photos for social media advertising and marketing.I do not authorize Get Up & Dance Fitness to use photos or videos of me on social media.
Signature
Date Signed

MonthDayYear
Date
Should be Empty:

Authorization and Release