Release and Authorization Form

Release, Authorization & Story Forms

Fields marked with an * are required

Companion Bridge has set forth certain policies regarding the health and medical care of all requesting financial assistance via Companion Bridge. In order to post a story and fund-raise on behalf of pet and persons requesting assistance, Companion Bridge needs full disclosure of veterinary records. Once this form is filled out correctly and you hit submit it will process and disappear. You will also receive a copy via email.

By typing my full name as an electronic signature above , I authorize Companion Bridge to use, reproduce, and/or publish photographs and/or video that may pertain to me and/or my pet—including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors.
This material may also appear on Companion Bridge website, Facebook or printed documents. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, Companion Bridge may publish materials, use my name, photograph, and/or make reference to me (including your pet) in any manner that Companion Bridge deems appropriate in order to promote/publicize service opportunities.

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