10/29/2014

Document1
Consent Form

A consent form must be received for each minor for whom the blanket permit is requested.


I hereby grant DISNEYLAND PARK the right to employ:


(name of minor)

for an episode of Candlelight Procession and Ceremony which is scheduled on

Saturday, December 6, 2014 and Rehearsal December 2 in Newbury Park
(dates of production, including rehearsals)

Signed: Date
(Parent or Guardian)


I also authorize DISNEYLAND PARK the right to administer emergency medical attention to
the above-named minor on the date of employment, should it be required.

Signed: Date:
(Parent or Guardian)
______

School Record

I certify that the above named minor meets the school districts requirements with respect to
age, school record, attendance and health.

School: San Marcos High School Date

Address: 4750 Hollister Avenue Santa Barbara, CA 93110

Signed: Title:
(School Principal/Vice-Principal/Dean or Counselor)

Remarks: Phone #:(805)967-4581

Minors Address:

City, State, Zip:

Age: Male/Female: Date of Birth:

Height: Weight:

Parent/Guardian Phone Number: