STUDENT 1: Name (goes by) *

First Name

Last Name

STUDENT 2: Name (goes by)

First Name

Last Name

STUDENT 3: Name (goes by)

First Name

Last Name

PARENT/GUARDIAN Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

(###)

###

####

Secondary Phone (work, cell) *

(###)

###

####

IMAGE RELEASE *

The Robinson Film Center, a nonprofit film education organization based in Shreveport, will present Summer Film Camps showcasing RFC's commitment to its mission to promote the highest standards in film and media education. RFC documents education programs through photography and video footage.

I hereby authorize the Robinson Film Center to document my child's participation in the film center's summer film camp program. I permit the Robinson Film Center to use photo, video and audio footage of my child in its promotional efforts, which include but are not limited to in-theater promotion, print, websites including social media, radio and TV.

How did you hear about our film camps? *

We want to know how you learned about our film camps. Please select all that apply

News (television, newspaper)

Facebook

Instagram

Saw a film camp yard sign

We've attended camp in the past

RFC email

Recommended by a friend

Other