A consent form must be received for
each minor for whom the Blanket permit is requested.
I hereby grant non•fic•tion
spots / PUBLICIS & HAL RINEY ADVERTISING the right
to employ ________________________________________________
Child's Name and
Birthdate
for an episode of SPRINT TELEVISION
COMMERCIAL which is scheduled on
Sunday, September 26th,
2004.
Signed: __________________________________
Date: ___________________
Parent or Guardian
I also authorize Medics at Movies
the right to administer emergency medical attention to
the above-named minor on the date
of employment, should it be required.
Signed: __________________________________
Date: ___________________
Parent or Guardian
SCHOOL
RECORD
Must
be signed by School Principal or Dean
I certify that the above named
minor meets the school district's requirements with respect
to age, school record, attendance,
and health.
School: Date: ____________________
Address: _______________________________________________________________
Signed: ___________________________________
Title: ________________________
Principal or Dean
Remarks: _______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________