Customer Photo Release Form

Customer Photo Release Form
Please complete this form to provide your consent for the use of your photographs as described below.
Full Name of Customer
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Event or Session Name (where photos were taken)
Date Photos Were Taken
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photographer or Organization Name
How may your photos be used?
Other (please specify)
Signature (Please sign below to confirm your consent)
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Date of Signature
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: