Photo, Video, and Social Media Consent Form Photo, Video, and Social Media Consent Form Name * Name First First Last Last Phone * Email * Patient Name * Sex * Species (Canine/Feline) * Breed * Photo, Video, and Social Media Consent I hereby grant Lincolnway Veterinary Clinic permission to use my pet's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications and social media, without payment or other consideration. I understand and agree that all photos will become the property of the Lincolnway Veterinary Clinic and will not be returned. I hereby irrevocably authorize the Lincolnway Veterinary Clinic to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my pet's likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Lincolnway Veterinary Clinic from all claims, demands, and causes of action which I may have by reason of this authorization. I have read and understand the above photo release. By checking "I consent", I affirm that I am at least 18 years of age, or if I am under 18 years of age, I have obtained the required consent of my parents/guardians. * I consent I do not consent Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
