Waiver for use of name and image

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

First Name:

Last Name:

Date:

YYYY

Home Phone:

Cell Phone:

Email Address:

Street Address:

City:

State:

Zip:

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.

YES - I grant unrestricted usage of my image and/or name without prior notification. I understand that there will not be any compensation for the use of these images.

NO - I do not grant unrestricted usage of my image and/or name without prior notification. I understand that there will not be any compensation for the use of these images.

Clear selection

Signature (Guardian):

Date:

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This form was created inside of Blitz Marketing Group.