Client Image Release Form

Call us at: +1 416 460 6184

First name:

Last name:

Email address

Phone number:

Project title:

Date

I understand that PhotosMosaic.com:

Will not share, sell, or distribute my images to third parties without my consent.

Will not use my images for any purpose other than what I have agreed to.

Will honor any request to withdraw my consent in writing, at which time PhotosMosaic.com will cease any use of my images and, if requested, remove them from public platforms within 30 days.

Consent to Use Personal Images:

With your permission, PhotoMosaics.com would like to use the images you provided for the purposes described below. Your consent is entirely voluntary, and you may withdraw it at any time. Please check off all uses you authorize.

Authorized uses:

Displaying a distance image of the the completed mosaic image on the PhotosMosaic.com website in a portfolio or gallery. Displaying a distance image plus close up details on the PhotosMosaic.com website in a portfolio or gallery. Sharing on social media platforms (e.g., Instagram, Facebook, etc.). Including in marketing or promotional materials (e.g., brochures, email campaigns, online advertisements). Using in printed material or exhibitions showcasing our work. Other (please description other applications below)

Other permitted uses

Option to Anonymize Images:

I would like my images to be used without identifying information (e.g., no names, locations, or personal identifiers).

Anonymize images

Yes, please anonymize my images. No, I am comfortable with my name or context being mentioned alongside the images.

Withdrawal of Consent:

I understand that I can withdraw my consent at any time by submitting a written request to PhotosMosaic.com at jonathan@vindens.ca.

Upon receiving my request, PhotosMosaic.com agrees to:

Immediately cease any future use of my images.

Remove my images from their public platforms within 30 days.

Permanently delete my images from their internal storage if requested.

Acknowledgement and Signature:

I have read and understand the terms of this Image Release Form and agree to the stated conditions.

Client Signature

By clicking here, I acknowledge I have read and understood this form, and agree to the stated conditions.

Signature