Photo/Video Release Form

I grant Veterinary Rehabilitation Services, LLC, its representatives and employees the right to take photographs and/or videos of me and/or my pet, and to copyright, use and publish the same in print and/or electronically.

I agree that Veterinary Rehabilitation Services, LLC may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.

Date

MM

DD

YYYY

Your name

First Name

Last Name

Your pet's name

The above MAY take photographs and/or videos of me and/or my pet

The above MAY take photographs and/or videos of me and/or my pet ONLY for purposes of adding them to my pet's medical records

The above MAY NOT take photographs and/or videos of me and/or my pet