Media PLAYdate Registration/Media Release 2025-2026

Your Name

Your Email

This address will receive a confirmation email

Your Phone

Your Address

Media Release

Consent and Release

I hereby grant permission to WonderSpace to record, photograph, film, or otherwise capture my profile and/or my child(ren)’s profile, likeness, image, voice, and performance (collectively, “Recordings”).

I understand and agree that WonderSpace may:

Display, copy, distribute, edit, enhance, modify, and otherwise use the Recordings,

In a variety of formats, including but not limited to: publications, print pieces, websites, email communications, social media, and video.

I further understand that:

All Recordings are the sole property of WonderSpace.

I waive any right to inspect or approve the finished product or use to which the Recordings may be applied.

I waive any right to royalties, compensation, or other remuneration arising from or related to the use of the Recordings.

This consent and release extends to all languages, media, formats, and markets now known or hereafter devised.

Acknowledgement

I affirm that:

I am of legal age and have the legal authority to grant this release on my own behalf and on behalf of my minor child(ren).

I have read and fully understand the terms of this release.

Electronic Signature: By entering my name is this box, I am providing my digital signature on this form.

This release is dated:

List of participants (co-parents, children, etc) included in this release for whom you are responsible at WonderSpace:

Participant One Name:

Participant One Birthday:

Participant One Relation:

Spouse/Coparent Child Other adult caregiver Other child in your care

Participant Two Name:

Participant Two Birthday:

Participant Two Relation: Spouse/Co-parent Child Other Adult Caregiver Other child in your care

Participant Three Name:

Participant Three Birthday:

Participant Three Relation: Spouse/Co-parent Child Other Adult Caregiver Other child in your care

Participant Four Name:

Participant Four Birthdate:

Participant Four Relation: Spouse/Co-parent Child Other Adult Caregiver Other child in your care

Participant Five Name:

Participant Five Birthdate:

Participant Five Relation: Spouse/Co-parent Child Other Adult Caregiver Other child in your care

Participant Six Name:

Participant Six Birthdate:

Participant Six Relation: Spouse/Co-parent Child Other Adult Caregiver Other Child in your care

Additional Participants Name, Birthday, Relation

Please indicate how many family members will be enjoying pizza during the event:

2 3 4 5 6+

Please indicate the number of family members that require a gluten free option: 1 2 3+

Media PLAYdate Registration/Media Release 2025-2026

Consent and Release

Acknowledgement

Description

Please Fix the Following