Blackish in Spokane guest casting and release form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

What age range are you?

City/Connection to Spokane

How do you describe your racial or cultural identity?

Do you identify as biracial or mixed?

If you are a Parent or caregiver of a biracial child, please describe your role.

Which best describes how you’d like to participate?

Are you comfortable being recorded for audio and video?

Topics you are open to discussing. Check all that apply

Topics you would prefer NOT to discuss.

For participants under 18

First NameLast Name

Child age

Parent or guardian name

First NameLast Name

Participant consent ( Adult 18+)

Signature

Date

Parent/Gaurdian Consent (Required)

Signature

Date

Is there anything that you’d like us to know before reaching out?

Thank you for sharing your information. Someone from blackish in Spokane will reach out if we believe your story is a good fit for an upcoming episode. Submitting this form does not guarantee participation, but we are grateful for your trust and interest