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PET PHOTO CONSENT FORM
I, ___________________, hereby grant ___________________ permission to use any
photographs taken of myself or my pet, in any and all of its publications, including
website entries, without payment or any other consideration. I understand and agree
that these materials will become your property and will not be returned. I hereby
authorize to edit, alter, copy, exhibit, publish or distribute this photo for purposes of
publicizing your programs or for any other lawful purpose.
In addition, I waive any right to royalties or other compensation arising or related to the
use of the photograph. I hereby release rights to all claims, demands, and causes to
action which I, my heirs, representatives, executors, administrators, or any other
persons acting on my behalf of my estate have or may have by reason of this
authorization. In signing this consent, I give authorization to use my name and my pet’s
name and information as printed below.
____________________________________
(Pet’s printed name)
____________________________________ __________________
(Owner’s Signature) (Date)
____________________________________
(Owner’s printed name)
Five Points Veterinary Services
