Children's Show Appearance Release Form
Please complete this form to provide consent for your child to participate and appear in the children's show.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 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 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent or Guardian's Email Address
*
example@example.com
Show Name or Title
*
Date of Show Appearance
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Does your child have any allergies or medical conditions we should be aware of? If yes, please specify.
Emergency Contact Name (other than parent/guardian)
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent or Guardian's Signature
*
Submit Consent
Submit Consent
Should be Empty: