Theater Cast Media Consent Form
Grant permission for the use of your image, video, and audio recordings during theater production activities.
Participant Full Name
*
First Name
Last Name
Participant Email Address
*
example@example.com
Participant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Production Name
*
Role/Character Name
*
Are you under 18 years of age?
*
Yes
No
Parent/Guardian Full Name (if under 18)
First Name
Last Name
Parent/Guardian Email Address (if under 18)
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
By signing below, I confirm that I have read and understood the media consent agreement and grant permission for the use of images, audio, and video recordings as described.
*
Submit Consent
Submit Consent
Should be Empty: