Educational Outreach Film Recording Consent
Please complete this form to provide your consent for film recording as part of our educational outreach activities.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you under 18 years of age?
*
Yes
No
If you are the parent or legal guardian of a minor participant, please provide your full name below to give consent on their behalf. (Leave blank if not applicable)
First Name
Last Name
Signature (Participant or Parent/Guardian)
*
Date of Consent
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: