Photo Consent Form

I hereby give Division Family Dental, and any and all employees and/or agents of Division Family Dental, the right and permission to use and/or publish photographs of me for art and promotional purposes including but not limited to, advertising, publicity, commercial or display of use. Also authorize my photos to be posted on social media, such as Facebook, Twitter, and the office’s website page

Release of Claims

I hereby release and discharge Division Family Dental and all persons functioning under his/her permissions or authority from any legal or equitable claims including but not limited to the following: blurring of the image(s), alteration, distortion or use in composite form, libel, invasion of privacy or any claims based on the production or in the process of recording or publishing the materials.

Select the following: Print

---