Theme Park Image Release Form
Please complete this form to grant permission for the use of your image or likeness captured at the theme park.
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you 18 years of age or older?
*
Yes
No (If no, parent/guardian information is required)
Parent/Guardian Full Name (if participant is under 18)
First Name
Last Name
Parent/Guardian Phone Number (if participant is under 18)
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event or Location within Theme Park
*
Date of Event or Visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Participant or Parent/Guardian
*
Submit
Submit
Should be Empty: