Pets Are Family

We are thrilled that you are willing to share your pet story with us on social media. Please fill out the form below. If you have more than one pet that you would like to share, we invite you to fill out two forms. 

All fields marked with * are required.

Pets Are Family

Information about you and your pet

AUTHORIZATION FOR PUBLICATION OF PHOTO

I hereby authorize Midwest Heritage to publish my photograph(s), in all media and for all types of advertising, publicity, promotion and other trade purposes for MH, its products and services.
My full name will be revealed in conjunction with my photo.
I understand that there will be no monetary compensation for my photo.
I also understand that my photo will be published for an indefinite amount of time.
I warrant that this consent and release for the use of Licensed Material does not in any way conflict with any existing commitment on my part.

No promise or representation which is not expressed in this consent and release has been made to me, and I have read this document, understand it and am signing it voluntarily.

1. Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.