Parent's Name *

First Name

Last Name

Phone

If applicable

(###)

###

####

Parent's Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Name

First Name

Last Name

Phone

If applicable

(###)

###

####

Birthday

MM

DD

YYYY

Photo Release Permision

I give WPC permission to use photographic portraits, pictures, digital images or video of my child, in which my child may be included in whole or part for any lawful purpose including, but not limited to, printed publications, video presentations and/or online.

Yes

No

Child's Name

First Name

Last Name

Phone

If applicable

(###)

###

####

Birthday

MM

DD

YYYY

Photo Release Permission

I give WPC permission to use photographic portraits, pictures, digital images or video of my child, in which my child may be included in whole or part for any lawful purpose including, but not limited to, printed publications, video presentations and/or online.

Yes

No

Child's Name

First Name

Last Name

Phone

If applicable

(###)

###

####

Birthday

MM

DD

YYYY

Photo Release Permission

I give WPC permission to use photographic portraits, pictures, digital images or video of my child, in which my child may be included in whole or part for any lawful purpose including, but not limited to, printed publications, video presentations and/or online.

Yes

No

Child's Name

First Name

Last Name

Phone

(###)

###

####

Photo Release Permission

I give WPC permission to use photographic portraits, pictures, digital images or video of my child, in which my child may be included in whole or part for any lawful purpose including, but not limited to, printed publications, video presentations and/or online.

Yes

No