Literacy Program Filming Consent Form
Please provide your consent for filming during the literacy program.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Full Name (if participant is a minor)
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Signature of Participant or Parent/Guardian
*
Submit
Should be Empty: