Media Consent Form I give my consent to Mahomet Animal Hospital, its affiliates and agents, to use my image(s) and any interview statement(s) from me and my pet(s) taken in or around the hospital in its publications including:I (first name)This consent includes, but is not limited to (check all that apply): Videos Email blasts Recruiting brochures Newsletters Magazines General Publications Website and/or Affiliates Internet, including but not limited to Facebook and Tiktok Otherexplain other:I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image(s).Please provide your tagging information for TikTok, Facebook, and Instagram. I do not give consent to Mahomet Animal Hospital, to use my image(s) and any interview statement(s) from me and my pet(s) taken in or around the hospital in its publications.I (first name)Client Name:Client #: ( number)Client SignatureReset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY The below signed parent or legal guardian of the above-named minor child hereby consents to and gives permission to the above on behalf of such minor child.Signature of Parent or Legal GuardianReset signature Signature locked. Reset to sign again Print Name
