Video and Photography Release Consent Form

Video and Photography Release Consent Form
Child's Name

First NameLast Name
Child's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Mobile Phone Number

Area CodePhone Number
Parent's Email
example@example.com
Parent or Guardian's Name

First NameLast Name
I (parent/guardian) hereby grant Pole Attack Kids Ltd and/orits associated subcontractors, the irrevocable right and permission to use andpublish any videos or pictures taken from our: classes, workshops, courses andany other associated service. We will use these images and videos withoutlimitation to advertise, promote and publicise through our website, leafletdistribution, social media channels and any other relevant advertising orpromotion methods. By signing this agreement, you warrant that you have readand understood this agreement.
Please verify that you are human
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty: