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Photo Release Form

"*" indicates required fields

I hereby grant Old Mill Hospital permission to take photographs of my pet and/or myself, and to publish those photographs for any lawful purpose, including, but limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I also grant permission to use my name and/or my pet’s name*.

Client First Name*

Client Last Name*

Client Phone Number*

If only granting permission for specific pets, please list those pets here.

By signing and dating this document, I authorize Old Mill Hospital to edit and share the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my or my pet’s image(s) and name(s) for the personal or commercial purposes outlined above.

Client Signature*

Date*

Name

This field is for validation purposes and should be left unchanged.