Theater Performance Consent Form
Please fill out this form to grant consent for participation in the theater performance.
Participant's Full Name
First Name
Last Name
Parent/Guardian's Full Name (if under 18)
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Performance Details
Please provide details about the performance.
Performance Title
Performance Date
-
Month
-
Day
Year
Date
Performance Location
Photography and Video Consent
Do you consent to the participant being photographed or filmed during the performance?
Consent for Photography/Filming
Yes, I consent
No, I do not consent
Use of Media
Do you consent to the use of photographs and videos for promotional purposes?
Consent for Use of Media
Yes, I consent
No, I do not consent
Medical Information
Please provide any relevant medical information or allergies.
Medical Conditions/Allergies
Additional Notes
Please provide any additional information that may be relevant.
Additional Information
Acknowledgment and Agreement
By signing below, you acknowledge that you have read and understood this consent form and agree to its terms.
Signature of Participant or Guardian
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: