ONE-TIME PARTICIPATION CONSENT FORM Date(Filming, Audio Recording, Performance, etc.) * City of Edmonton, Province of Alberta, Canada MM DD YYYY 1. Parties to the Agreement * 1.1. The producer center Publish Art Productions Inc. (Alberta Corporate Access Number: 2027086343), represented by authorized representative Svetlana Pavlish (hereinafter referred to as “the Producer Center”), on one side, and 1.2. The parents/legal guardians: First Name Last Name acting on behalf of their minor child: * Child’s Full Name First Name Last Name Date of Birth MM DD YYYY 2. Event Description * 2.1. The parents grant permission for the child to participate in the following event: (specify the event and its nature) filming recording concert 2.1 The event will be held on: * MM DD YYYY 2.2 Time Hour Minute Second AM PM 2.3. The purpose of the event is to produce a creative, audio, video, or stage work as part of the projects of the LUME Children's Film Studio and the Production Company. 3. Parental Responsibility 3.1. The parents accept full responsibility for the child’s health, safety, and behavior throughout the event, including travel to and from the location. 3.2. At least one parent or legal guardian must be present during the event. The Production Company does not assume responsibility for supervising or escorting the child in the absence of a parent. 4. Rights to Use Materials 4.1. The parents agree to allow photography, video recording, and audio recording of the child during the event. 4.2. The parents consent to the non-commercial publication and use of the resulting materials (photo, video, audio) on the Production Company’s media platforms, including websites, social media, presentations, and promotional materials. 4.3. If the recorded material is later used for commercial promotion or profit, a separate agreement will be signed with the parents specifying the terms of compensation and usage. 4.4. Parents are not permitted to publish, distribute, or post any footage, photos, or recordings made during the event without prior written permission from the Production Company. 11. Agreement Confirmation (required) * Production Company: Publish Art Productions Inc. Alberta Corporate Access Number: 2027086343 Authorized Representative: Svetlana Pavlish Signed electronically on behalf of the company. Parents / Legal Guardians of the Child: Please enter your full name(s) below. This will serve as your electronic signature confirming agreement to all terms above. First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * Country (###) ### #### Date * MM DD YYYY Consent Statement (required) * By entering my name and submitting this form, I confirm that I am the legal parent or guardian of the participant and agree to all terms of this agreement. Thank you!
