CLIENT PICTURE RELEASE FORM

I'd first like to thank you for making the choice to allow me to use your pictures and/or testimonials on my website and in my business materials. Your help allows me to continue growing this outreach to women just like you, searching for the perfect doula. I can't wait to use the resources you are giving me, and I am looking forward the possible outcomes your generosity will bring.

As you already know, I have sent you a list of pictures, video's or testimonies I would like to to use on my site, and I asked you to look over each item to ensure you are happy with the materials I plan on using. I ask that you look over the specific files once more to ensure you are 100% happy with the materials I hope to use. 

If you are absolutely sure the materials I attached are acceptable for me to use, please fill out the following form fully.

Thank you again for allowing me to use your materials to better my business, and I look forward to using them in my future work.

Your Name *
Your Name
Your Home Address *
Your Home Address
Your Phone Number *
Your Phone Number
Terms Of Agreement *
I hereby give Katie Tolbert and Peace On Birth the right to use any quoted material, photography, or video footage provided on Friday, February 20, 2015 as listed in connected email correspondence. Any of the photography or video footage listed in the e-mail has been fully examined and curated me for the use of Katie Tolbert and Peace On Birth. I acknowledge the following materials/information may be used for the purpose of developing any of the following mediums: The Peace On Birth website, printed Peace On Birth business materials, or published Peace On Birth audio/video broadcasts. I fully understand that I will not be financially compensated for use of listed materials/information or direct quote(s) I provide.
Please type your name below followed by the birthdate of the child we assisted you with in the box below to confirm your identity. An example of an signature is listed in the box below for Jane Smith, who had a baby boy on September 30, 1995.