Restaurant Photo & Media Release Waiver

Restaurant Photo & Media Release Waiver
Please complete this form to provide your consent for the use of your photos and media in restaurant promotions.
Full Name
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
Relation to the Restaurant
Other
Event or Occasion (if applicable)
Date of Consent
MonthDayYear
Date
Preferred Contact Method
Special Requests or Restrictions (please specify if any)
Signature
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