Youth Club Documentary Consent Form
Please complete this form to provide consent for the youth club to document activities involving minors. Your responses are essential for participation in the documentary project.
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
Participant's Youth Club Branch/Location
*
Please Select
Downtown
Eastside
Westside
Northside
Southside
Other
Guardian's Full Name
*
First Name
Last Name
Guardian's Relationship to Participant
*
Please Select
Parent
Legal Guardian
Grandparent
Other
Guardian's Email Address
*
example@example.com
Guardian's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Documentary Project Name
*
Consent for Participation and Use of Image/Video
*
I, as the guardian, consent to the youth club filming, photographing, and using images or video of the participant named above for the purposes of the youth club documentary project. I understand these materials may be used in club communications, promotional materials, and public presentations. I confirm I am authorized to provide this consent.
*
I agree and provide consent
Submit Consent
Should be Empty: