Parental Consent Form

This is what we asked both of our young actors to sign as to allow them to appear in our short film.

Parental Consent for Photographic/Film Use of Children under 18 years of age I, (adult’s name) ____________________________________________________________________
of (address)________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
being the child/children’s parent or legal guardian, hereby give permission for
Zapp Production Company to take and use publicity photographs/film of
(child/children’s name/s) _________________________________ Age of child__________________
______________________________________________________ Age of child _________________
______________________________________________________ Age of child _________________
for upload to Dunraven Blogger and youtube channel where they may be viewed by the public.
I also consent to use of the photos for publicity, marketing, and advertising for Zapp Productions, for publicity, marketing, and advertising.
I agree that the photos/film may be combined with other images, text and graphics and
be cropped, altered or modified in any way which Zapp Productions deems appropriate.
I consent to the provision of this form and the details within it to be stored on Zapp Productions’ private database.
I understand that the child’s/children’s name/s will not be given to press or public without my consent. I also understand that I may cancel this permission in writing, and that Zapp Productions will take all reasonable steps to ensure that the photograph/film is withdrawn from future use.
I further understand that I shall receive no remuneration for this assistance.
Signed: ___________________________________________
Date: _________________