MEDIA RELEASE Form – CHAUFUR Pet Transit

Is This Form Being Completed By A Business/Organization?

Yes

No

Pet Parent Name

First

Last

Date of Birth

Pet Parent Email

Pet Parent Phone

Business Name

Business Category

Business Phone

Business Description

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Please share with us what you do!

Business Address

City

State/Province

Zip/Postal

Point of Contact Filling Out This Form

First Name

Last Name

Legal Authorization

I am a representative of the above named business where I have authority to make decisions about employees and animals in their care, particularly in relation to the release of media in which they are featured.

Point Of Contact Email

Point Of Contact Phone

Extension

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 For Residential Customers

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 and submitting this form, you agree to be bound by, and to comply with, these Terms and Conditions.

Terms and Conditions For Businesses

As an authorized representative of the above named business, 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 all its employees, agents, designees, and pets in their care 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 its 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 employed by or a representative of the business stated above and am authorized to accept these terms and conditions in their behalf.

As a representative of the above named business, you agree for said business to be bound by, and to comply with, these terms and conditions by checking this box and submitting this form.

Date of Agreement