I give my consent for my child_(name)________________________________________
Date of birth____________________________________________________________
To take part in__________________________________________________________
Your Address___________________________________________________________
Emergency Contacts___________________________________________________
Any Medical Conditions_______________________________________________
___________________________________________________________________________
___________________________________________________________________________
I understand that The Film Workshop, The Golden Learning Summer Camp,  The Lutheran Redeemer
Church or the said property will take great care of your child. However, we cannot be responsible for liable behavior, 
loss of personal property and injury suffered by your child.
_______check here to OK.

Photography: Since this is a media workshop there will be pictures and film of your children for learning experience.
If you choose not have your child in any media please state so here_______________________________________________________
__________________________________________________________________________________________________________________________________
Signature of parent or guardian______________________________________________________________________________________________