Photograph Release Form

Broadway Animal Hospital Photograph Release

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

I hereby authorize Broadway Animal Hospital to publish photographs taken of my pet(s) and my pet(s) name and likeness, for use in Broadway Animal Hospital's print, online and video-based marketing materials, as well as other Broadway Animal Hospital’s publications. I hereby release and hold harmless Broadway Animal Hospital from any reasonable expectation of privacy or confidentiality associated with the images specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in company marketing materials or other publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release Broadway Animal Hospital, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation. Please indicate which forms of social media you authorize: *

I have read and understand.

Broadway Animal Hospital Website *

Yes
No

Facebook *

Yes
No

Instagram *

Yes
No

TikTok *

Yes
No

Patient Name(s) *

Owner's Printed Name *

Email *

Signature *

Clear Signature

Date *