Photo Release Form

PERMISSION TO USE PHOTOGRAPH(S) AND VIDEOS TAKEN DURING TREATMENT.

Date:

MM

DD

YYYY

Professional Providers Location:

I grant to Jane Esthetics Skincare Spa, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Jane Skincare Spa its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that Jane Esthetics Skincare Spa and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Signature

I have read and understand the above.

First Name

Last Name

Date of Signature

MM

DD

YYYY

Photo Release Form

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