Portrait Release & Consent

Thank you for allowing Pro Vision Multimedia Enterprises to photograph you as part of the Legacy Photos program. Please complete the fields below, type your name to sign, and click Send. Your release will go directly to Rothstein's inbox — no download or email attachment required.

I grant Pro Vision Multimedia Enterprises the perpetual, worldwide, royalty-free, non-exclusive right to photograph me and to use, publish, and reproduce my likeness, portrait, name (first name only unless otherwise agreed), and any resulting images in the Photographer's marketing, website, printed portfolio, framed display samples, brochures, and social-media accounts. I waive any right to inspect or approve the finished images or the use to which they may be applied. I understand no monetary compensation is due to me for this grant, and I release the Photographer from any claim arising from the use of the images consistent with this release.

Subject Information

Subject's Full Printed Name *

Community / Facility

Date of Portrait Session

Email (optional — for confirmation)

Signature

Type your full name to sign *

Your typed name below is your signature.

— signature will appear here —

Signed on *

Signing on behalf of the subject? (Power of Attorney / family member) — tap to open

Complete this section only if the subject cannot sign for themselves. A power of attorney, spouse, adult child, or legal guardian may sign on the subject's behalf.

Representative's Printed Name

Relationship to Subject

Representative — type name to sign

Yes — please send me a complimentary print of my portrait as a thank-you.

Mailing address

Leave this field blank

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Thank you!

Your Legacy Photos release has been sent to Rothstein. If you asked for a print of your portrait, it will be mailed to the address you provided.

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