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Photo Permission and Release

I give Kidsapia permission to photograph my child and/or take video footage. These photographs and/or videos may be used by Kidsapia for marketing and promotional material in Kidsapia publications, advertisements, customer loyalty material and/or on their website and social media. Names will not be identified with any photo/video images.

First Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*

Phone*
First Parent/Legal Guardian Date of Birth*
I certify that I am 18 years of age or older
First Parent/Legal Guardian Signature*
Second Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Second Parent/Legal Guardian Date of Birth*
Third Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Third Parent/Legal Guardian Date of Birth*
Fourth Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Fourth Parent/Legal Guardian Date of Birth*
Fifth Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Fifth Parent/Legal Guardian Date of Birth*
Sixth Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Sixth Parent/Legal Guardian Date of Birth*
Seventh Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Seventh Parent/Legal Guardian Date of Birth*
Eighth Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Eighth Parent/Legal Guardian Date of Birth*
Ninth Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Ninth Parent/Legal Guardian Date of Birth*
Tenth Parent/Legal Guardian Name

First Name*

Middle Name

Last Name*
Tenth Parent/Legal Guardian Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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