Talent Media Release Form

Student's Name*

First NameLast Name
Parent's Name*

First NameLast Name
Contact Email*

Confirmation Emailexample@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of School*
Year Level*
Please take a quick photo of the child to be photographed/videoed for our reference.
Signature*

Clear
YouthCARE is committed to ensuring that the information you provide to us is accurate and remains secure. All written materials containing your details are stored in secure areas and computer records can only be accessed by authorised personnel.
Should be Empty: