Media Release Form – CHAUFUR Pet Transit

Pet Parent Name

First

Last

Date of Birth

Pet Parent Email

Pet Parent Phone

Pet Parent Address

City

State/Province

Zip/Postal

Country

Pet

Pet Name

First

Last

Date of Birth

Species

Subspecies/Breed

Pet Description

0 of 250 max characters

Color, short/long haired, build (small,medium, large) etc.

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Terms and Conditions

I hereby grant CHAUFUR Pet Transit, its directors, officers, employees, agents, and designees (collectively “CHAUFUR LLC”) non-revocable permission to capture the image and likeness of myself and my pets in videotapes, motion pictures, recordings, or any other media (collectively “Images”). I acknowledge that CHAUFUR LLC will own such Images and further grant CHAUFUR LLC permission to copyright, display, publish, distribute, use, modify, print and reprint such Images in any manner whatsoever related to CHAUFUR LLC business, including without limitation, publications, advertisements, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by CHAUFUR LLC prior to its use. I forever release and hold CHAUFUR LLC harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity.

PLEASE NOTE: CHAUFUR LLC reserves the right, at their sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name. This release is binding on me and my heirs, assignees and personal representatives.

By checking this box, you agree to be bound by, and to comply with, these Terms and Conditions.

Date of Agreement