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Rogue Rock Gym - Guardian Media Release Consent for Minors

NOTICE: THIS IS A LEGALLY BINDING CONTRACT BETWEEN MYSELF AND CHRYSALIS, LLC dba ROGUE ROCK GYM (hereinafter "RRG").

I, the parent or legal guardian of the minor named below, hereby authorize RRG to photograph, video record, and/or otherwise capture the likeness of said minor for use in RRG’s promotional materials, including print, digital, online, and video-based formats.

I understand and agree that:

1. These materials may be used for promotional purposes including, but not limited to, brochures, social media, websites, and advertisements.

2. I waive any rights to inspect or approve the finished images or marketing content in which the minor’s likeness appears.

3. Participation is voluntary, and no financial compensation will be provided for the use of such images.

4. I release and hold harmless RRG, its employees, contractors, and partners from any claims, demands, or causes of action related to the use of the minor’s image, name, or likeness.

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.


Date: June 19, 2026

First Guardian's Name
First Name*
Last Name*
Phone*
First Guardian's Date of Birth*
Date of Birth
First Guardian's Signature*
Second Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Third Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Fourth Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Fifth Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Sixth Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Seventh Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Eighth Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Ninth Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
Date of Birth
Tenth Guardian's Name
First Name*
Last Name*
Guardian's Date of Birth*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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