Media Release Form

Name

First Name

Last Name

Preferred Pronouns

Age

Date of Birth

YYYY

Phone Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Authorization, Release, and Consent

Can we use your name?

Complete name

First name

Last name

Anonymous

Authorization

I authorize and grant SOLO SCOOP CREAMERY LLC to take my photos and/or video.

I grant SOLO SCOOP CREAMERY LLC to use my photos/videos on Facebook, Twitter, Instagram, and other social media platforms.

I allow SOLO SCOOP CREAMERY LLC to edit, alter, copy, or distribute the photos and/or videos for social media advertising and marketing.

I agree that the photos belong to SOLO SCOOP CREAMERY LLC.

I understand that I will not receive any monetary compensation.

Signature

By typing your name below, you are signing this media release form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.