Release for Media Recording

Owner and Pet Information

Name

First

Last

Address

City

State/Province

Zip/Postal

Email

Phone

Pet Name

Which is a:

(Dog, Cat, etc.)

Acknowledgements and Authorizations

I, undersigned, do hereby consent and agree that Veterinary Care Center of Richmond, it’s employees, or agents have the right to take photographs, videotape, or digital recordings of my pet and to use these in any and all media, now or hereafter known, and exclusively for the purpose of advertising and website promotion. I further consent that my pet’s name and identity may be revealed therein or by descriptive text or commentary.

I consent

I do hereby release Veterinary Care Center of Richmond, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my pet’s identity or likeness in whatever media is used.

I hereby release

I understand that there will be no financial or other remuneration for recording me or my pet, either for initial or subsequent transmission playback.

I understand

I also understand that the Veterinary Care Center of Richmond is not responsible for any expense or liability incurred as a result of my pet’s participation in this recording, including medical expense due to any sickness or injury incurred as a result.

I understand

I represent that I am at 18 years of age, have read, and understand the foregoing statement, and am competent to execute this agreement on behalf of my pet.

I am of 18 years of age

Signature

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Date

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Release for Media Recording

Owner and Pet Information

Acknowledgements and Authorizations

Contact Info

Highlighted Partners

Emergency Partners

Patient Forms