2619 SW 17th St, Topeka, KS 66604
(785) 233 - 3185

Pet Photo Release Form

Fields marked with an asterisk (*) are required.

I hereby grant University Veterinary Care Center, P.A. permission to use any photographs taken of myself or my pet, in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become your property and will not be returned. I hereby authorize to edit, alter, copy, exhibit, publish ordistribute this photo for purposes of publicizing your programs or for anyother lawful purpose.  In addition, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby release rights to all claims, demands, and causes to action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of my estate have or may have by reason of this authorization. In signing this consent, I give authorization to use my name and my pet’s name and information as completed below. 

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