Image Release Form Date(Required) MM slash DD slash YYYY Pet's Name(Required)Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Enter Email Confirm Email Media Release(Required) I hereby grant Benson Veterinary Enterprises, Inc., DBA Paws into Grace permission to use my likeness and/or my pet’s/pets’ likeness in photograph(s)/video(s) in any and all of its publications and in any and all other media, whether now known or hereafter existing. This release relates to photographs/videos intended for use in any hospital publication or a marketing or public relations nature, such as newsletters, brochures, websites/blogs/social networking sites, promotional items, or other such material. I will make no monetary or other claim against Benson Veterinary Enterprises, Inc. for the use of photograph(s)/video(s).
