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Photo Release Form
Animal Hospital / Veterinary Practice
(Required)
Please enter the full name of the veterinary practice.
Name of Participant
(Required)
Pet Name (s)
Phone
Email
(Required)
Do you work at this hospital?
(Required)
No - I am a client
Yes, I am an employee / Owner
What is your position at this practice?
(Required)
Signature
I hereby grant to this veterinary practice and/or Cheshire Partners, LLC., the absolute and irrevocable right and unrestricted permission in respect of photographic portraits, editorial or any pictures or videos this veterinary practice and/or Cheshire Partners, LLC. has taken of me, or my pet, or in which I may be included with others, to copyright, to re-use, publish and republish the same in whole or in part, individually or in conjunction with other photographs, in any and all media now or hereafter known, and for any other purposes whatsoever, for illustration, promotion, art, editorial, advertising and trade, or any other purpose whatsoever without restriction as to alteration; from time to time, or reproductions thereof in color, black and white or otherwise. I understand that the photos maybe used in a publication, print ad, direct mail piece, electronic media, (video cd-rom, internet, world wide web), or other forms of promotion. I understand that the photographs taken by Cheshire Partners LLC. may be included in stock files. I agree that the photographs, the transparencies thereof and the rights to copyright the same, shall be the sole property of this veterinary practice and/or Cheshire Partners, LLC. with full right of lawful disposition in any manner. I hereby waive any right that I may have to inspect or approve the finished products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied. I hereby release, discharge and agree to save harmless this veterinary practice and/or Cheshire Partners, LLC. its legal representatives or assigns and all persons acting under its permission or authority, from any liability in connection with the use of the photographs of me or the participant as aforesaid or by virtue of any alteration, processing or use thereof in composite form, whether intentional or otherwise, as well as any publication thereof. I hereby grant permission to this veterinary practice and/or Cheshire Partners LLC. to photograph me or my pet during activities to use the photographs in this veterinary practice and/or Cheshire Partners, LLC. promotional materials and publicity efforts, audio-visual and printed materials without compensation or approval rights.
Consent
I agree to the statements listed above.
Date
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.