______ Signature of Pet Owner Date [PDF]

HOMETOWN BED & BISCUITS 6137 Franconia Road, Alexandria, VA 22310 Phone: (703) 922-8059 Fax: (703) 922-8030 hometownvetclinic.net Find us on:

I hereby grant Hometown Veterinary Clinic and Hometown Bed & Biscuits (Hometown) the irrevocable right and permission to use photographs and/or video recordings of my pet(s) on Hometown and other websites and in publications, promotional flyers, or for any other similar purpose without compensation to me. I understand and agree that such photographs and/or video recordings of my pet(s) may be placed on the Internet. I also understand and agree that my pet(s) may he identified by name in printed, Internet or broadcast information that might accompany the photographs and/or video recordings. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof are and shall remain the property of Hometown. I hereby release, acquit and forever discharge Hometown and its owners and ernployees from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including, but not limited to any claims for invasion of privacy or appropriation of likeness. I hereby warrant that I am eighteen (18) years of age or more and competent to contract. This release is binding on me and my heirs, assigns and personal representatives.

__________________________________________ Signature of Pet Owner

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__________________________________________ Signature of Witness

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