Parental Consent Form | LWS Media Network

Important: All fields marked with * are required. By submitting this form you confirm that you are the parent or legal guardian of the minor named below and that you have read and understood all consent clauses. A copy of your submission will be sent to editor@lwsmedianetwork.com for our records.

Consent Form Submitted

Thank you. We have received your consent form and a copy has been sent to our team. We will be in touch shortly to confirm next steps. If you have any questions contact us at editor@lwsmedianetwork.com

Details of the Minor

Full Name of Minor *

Please enter the minor's full name.

Date of Birth *

Please enter the minor's date of birth.

Age at Time of Participation *

Nationality

School / Organisation (if applicable)

Parent / Guardian Details

Full Name *

Please enter your full name.

Relationship to Minor *

Email Address *

Please enter a valid email address.

Phone Number *

Please enter your phone number.

Mailing Address

Nature of Participation

Type of Feature *

Approximate Date(s) *

Story Title or Topic *

Location of Interview / Shoot

Consent — Please check each box to confirm

Restrictions or Special Instructions (Optional)

Please note any restrictions on the use of your child's image, name, or content

Declaration

By submitting this form I confirm that:

• I am the parent or legal guardian of the minor named above.

• I have read and understood this consent form in full.

• I give my free and informed consent for the participation described above.

• I understand that no payment or compensation is implied unless separately agreed in writing.

• All information provided is accurate and truthful.

Full Name (as signature) *

Please type your full name as your signature.

Date *

A copy of this submission will be sent to editor@lwsmedianetwork.com for our records.