CinemaKidz Media Release Form

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Please fill out the following form, in order for your child to attend a CinemaKidz-hosted event.

Questions? Feel free to call us at (347) 699-6401

* Indicates required question

Do you agree to the above CinemaKidz Media Release outlined above?

Yes, I hereby agree to the above statement

No, I do not agree

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Primary Guardian's Full name *

Your answer

Your Child's Full Name *

Your answer

Your Email *

Your answer

Name and date of event you are attending *

Your answer

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