TESTIMONIAL RELEASE FORM

Thank you so much for sharing your GENUINE story with us!

We want to share the benefits of GENUINE with every dog owner. In particular, we would greatly appreciate the opportunity to share your particular testimonial on social media and other promotional outlets.

If you are interested and willing to let us share your testimonial, please complete the form below.

Thank you again for supporting GENUINE.

Name of Pet Owner *

First

Last

Date of Birth

Any format is fine 🙂

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Can We Use Your Name? *

Complete Name
First Name
No name is to be used

Name(s) of Pet(s) *

If there are multiple pets, please separate their names with a comma.

Can We Use Your Pet's Name? *

Conditions *

I agree to the following terms:

I hereby grant GENUINE (PET HEALTH DELIVERED, LLC), its directors, officers, employees, agents, and designees (collectively “PET HEALTH DELIVERED, LLC”) non-revocable permission to use our testimonial submissions - including our pet’s image and likeness on advertisements and promotional material (digital and traditional), as well as on Facebook, Twitter, Instagram, Tik Tok, YouTube, Snapchat and other social media platform

I acknowledge that PET HEALTH DELIVERED, LLC will own such Images and testimonial content and further grant GENUINE (PET HEALTH DELIVERED, LLC) permission to copyright, display, publish, distribute, use, modify, print and reprint such Images and testimonial in any manner whatsoever related to PET HEALTH DELIVERED, 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 Images and testimonial content by GENUINE (PET HEALTH DELIVERED, LLC) prior to its use. I forever release and hold GENUINE (PET HEALTH DELIVERED, 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.

I understand that I will not receive any monetary compensation.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assignees and personal representatives.

Date of Agreement *

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