Waiver for use of name and image
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First Name:
Last Name:
Date:
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Email Address:
Street Address:
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Do you grant unrestricted usage of your image and/or name without prior notification?  And, acknowledge that there will not be any compensation for the use of these images?  Such use includes the display, distribution, publication, transmission or other use of photographs, images, and/or videos taken for the use in materials that include but not limited to printed materials such as brochures, newsletters, videos and digital images on Loving All Animals’ website or social media sites.  
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Signature (Guardian):
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