Photo & Video Release Form

I, the client, hereby grant and authorize CAROLINA PINTOS THERAPY, PLLC and its team, employees, and/or associates the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video was taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites, and other print and digital communications, without payment or any other consideration. 

This authorization extends to all languages, media, formats, and markets now known or later discovered.

This authorization shall continue indefinitely unless I otherwise revoke this authorization in writing.

I, the client, waive the right to inspect or approve any finished product in which my likeness appears, including a written or electronic copy.

I, the client, agree that I have been compensated for this use of my likeness or have otherwise agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the photograph. 

I, the client, understand and agree that these materials shall become the property of CAROLINA PINTOS THERAPY, PLLC

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Signature Certificate
Document name: Photo & Video Release Form
lock iconUnique Document ID: 3e359e62764f035bddbf1c271197ad9bcf26ed8b
Timestamp Audit
January 25, 2020 1:24 am CDTPhoto & Video Release Form Uploaded by Carolina Miranda - [email protected] IP 2601:2c1:8400:6af0:fd89:b0dc:e703:5838