Media Release For good and valuable consideration, receipt of which is hereby acknowledged, I hereby consent to the reproduction, publication, or other use by Walnut Creek Veterinary Clinc, its successors and assigns, for commercial advertising or any other purposes of my name and/or my pet’s name, photograph, likeness, voice and/or personal data, given, photographed and/or recorded on or about Date MM slash DD slash YYYY Location Furthermore, I hereby release Walnut Creek Veterinary Clinc, its owners, officers, employees, successors and assigns from all claims which I might have in connection with any use of my name and/or my pet’s name, photograph, likeness, voice and/or personal data. I represent that I am of legal age. Date MM slash DD slash YYYY SignatureI am the legal guardian of the minor child named below and hereby ratify this Consent and Release signed by such minor. Date MM slash DD slash YYYY Guardian SignatureMinor SignatureCAPTCHA Δ
