RTC Parental Consent for Media Release
Please complete this form to authorize the use of your child's image, video, or audio for media or promotional purposes for The Roo Theatre Company.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Parent or Guardian's Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Legal Guardian
Other
Parent or Guardian's Email Address
*
example@example.com
Parent or Guardian's Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Type of Media to be Released
*
Photographs
Video Recordings
Audio Recordings
Other
Signature of Parent or Guardian
*
Date of Consent
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Comments (optional)
Submit Consent
Submit Consent
Should be Empty: