Publicity Release Form Carlson

Publicity Release Form
In the course of advertising, public relations or other similar conduct for business
purposes, CARLSON ANIMAL HOSPITAL may utilize for media resources.

I grant CARLSON ANIMAL HOSPITAL, it’s representatives and employees the right to take photographs of me and/or my pet to copyright, use and publish the same in
print and/or electronically without compensation.

I also agree the CARLSON ANIMAL HOSPITAL 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. This
would be true of any written statement I have made regarding my pet or my
experiences at CARLSON ANIMAL HOSPITAL.
Do you consent to the above? *

The representatives and employees of CARLSON ANIMAL HOSPITALhave my consent to take photos for purposes intended listed above, ofme and/or my pet(s) listed below. The representatives and employees of Carlson Animal Hospital mayNOT take photos of me and/or any of my pet(s)
Pet Name *
Owner Name *

First Name Last Name
Signature *

Clear
Today's Date *

Month Day Year
Date
Should be Empty: