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Media Consent and Photography/Videography Release

SiRa Dentistry · 3rd Annual Pet Halloween Costume Contest · Friday, October 16, 2026 · 5:00–8:00 PM · 456 Main Street, Spotswood, NJ 08884

This Media Consent and Photography/Videography Release (this “Release”) is entered into by the undersigned individual, on behalf of themselves or other individuals who the undersigned individual may register at the other individuals’ request and any minor child(ren) and companion animal(s) accompanying them (collectively, “Subject”), in favor of SiRa Dentistry and its owners, doctors, employees, agents, marketing personnel, and contracted photographers or videographers (collectively, “SiRa Dentistry”), in connection with the 3rd Annual Pet Halloween Costume Contest, held Friday, October 16, 2026, 5:00 PM–8:00 PM at 456 Main St, Spotswood, NJ 08884 (the “Event”).

1. Grant of Consent

Subject understands that SiRa Dentistry, its staff, and its contracted photographers and videographers may capture photographs, video recordings, and audio recordings at the Event that may include Subject’s image, likeness, voice, name, and/or the image or likeness of Subject’s pet(s) (collectively, the “Media”). By attending the Event, Subject consents to being photographed and/or recorded, and grants SiRa Dentistry the rights described in this Release.

2. License to Use Media

Subject grants SiRa Dentistry a perpetual, irrevocable, worldwide, royalty-free, and non-exclusive right and license to use, reproduce, edit, modify, publish, distribute, and display the Media, in whole or in part, alone or in combination with other content, in any and all media now known or hereafter developed, including but not limited to:

• SiRa Dentistry’s website and patient portals;
• Social media platforms, including Instagram, Facebook, TikTok, LinkedIn, and YouTube;
• Email newsletters, SMS/text marketing, and patient communications;
• Print materials, including brochures, flyers, signage, and direct mail;
• Paid advertising, including digital, print, and broadcast advertisements; and
• Press releases and submissions to local news or media outlets covering the Event.

SiRa Dentistry may use the Media for marketing, advertising, promotional, and archival purposes related to SiRa Dentistry and future community events, including the promotion of future Pet Halloween Costume Contests or similar events.

3. No Compensation

Subject acknowledges that participation in this Release is voluntary and that Subject will not receive any payment, royalty, or other compensation for the use of the Media, now or in the future.

4. No Obligation to Use

Subject understands that SiRa Dentistry is under no obligation to use any Media featuring Subject or Subject’s pet, and that SiRa Dentistry may, in its sole discretion, edit, crop, or decline to publish any Media captured at the Event.

5. Minor Children

If Subject’s minor child(ren) will be present at, or appear in Media captured at, the Event, the parent or legal guardian signing represents that they have the legal authority to consent to their minor child’s appearance in the Media on the child’s behalf, and grants the same rights described in this Release with respect to their minor child’s image, likeness, voice, and name.

6. No Right of Review or Approval

Subject understands that, except as required by law, Subject will not have the right to inspect, approve, or object to the specific finished Media, or the specific manner in which the Media is used, prior to publication.

7. Release of Claims

Subject releases SiRa Dentistry from any and all claims, demands, or causes of action that Subject may have arising out of or relating to the use of the Media as authorized by this Release, including without limitation any claims for invasion of privacy, defamation, or violation of any right of publicity, to the fullest extent permitted by applicable law.

8. Revocation

Because Media may be published and shared widely upon capture, Subject understands that this consent is granted on a going-forward basis and that SiRa Dentistry cannot guarantee the removal of Media that has already been published, shared, reprinted, or distributed by SiRa Dentistry or by third parties (including on social media) prior to any request for revocation. Subject may request that SiRa Dentistry cease future use of specific Media by submitting a written request to SiRa Dentistry’s office.

9. Governing Law

This Release shall be governed by and construed in accordance with the laws of the State of New Jersey, without regard to its conflict-of-laws principles.

10. Entire Agreement

This Release constitutes the entire agreement between Subject and SiRa Dentistry regarding its subject matter and supersedes all prior or contemporaneous understandings, whether written or oral, regarding that subject matter.

BY SIGNING, I CONFIRM THAT I HAVE READ AND UNDERSTAND THIS MEDIA CONSENT AND PHOTOGRAPHY/VIDEOGRAPHY RELEASE, AND THAT I VOLUNTARILY CONSENT TO ITS TERMS ON BEHALF OF MYSELF, MY MINOR CHILD(REN), AND MY PET(S).

Return to the registration page to sign this document electronically and complete your registration.