"*" indicates required fields

MM slash DD slash YYYY
Client’s Name*
Address*
Alternate Contact Name*

AUTHORIZATION

PHOTO RELEASE FORM

I grant to Martinez Animal Hospital, its representatives and employees the right to take photographs of me and/or my pet(s), and to copyright, use and publish the same in print and/or electronically. I agree that Martinez Animal Hospital may use such photographs of me and/or my pet(s) with or without my name and for any lawful purpose, including for example, such purposes as publicity, illustration, advertising, and web content.
The above may / may not (SELECT ONE) take photos of me and/or my pet(s)*
Full Name
Address*
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.