Parent Name

First Name

Last Name

Phone

(###)

###

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Student Name *

First Name

Last Name

I would like an Individual photo of my child

this is an additional $10.00 to the Christmas Dance Package.

Yes

No

Photos may be used for advertising & publicity

Advertising and publicity includes social media posts, website posts and other advertising venues.

Yes

No

Photo Disclosure Agreement *

I grant permission to Wildwood Ballet to take individual and group photos and video of my child. Photos will not be used for publicity reasons, unless approved by parent. Please print your name in agreement.

First Name

Last Name