Registration and Permission Slip

(please print, fill out and mail with your payment to Alla Markova, 6801 19th Ave #4C, Brooklyn, NY 11204

To reserve the space you may email the scanned form to azbuki1@yandex.ru; however, until we get your payment the registration is not completed)

I _________________________ , cell phone number _______________________
email address _______________________________________________________
parent/legal guardian of (child’s name and age)_______________________     
permit my child participate in the outdoor role game organized by the Malenkaya Kompaniya

on June 19, 2010 at Prospect Park, from 12 noon to 3PM.

I take all responsibility for his/her behavior during the game and will supervise my child during the game.

On the day of the game I will bring the child to the Prospect Park on time (dressed appropriately for such a game – old cloths and sneakers).
I will allow pictures/videos of my son/daughter to be taken by the Malenkaya Kompaniya during the game.

Child’s name MAY / MAY NOT be disclosed. (Please circle the applicable phrase.)

With your permission, the Malenkaya Kompaniya will take pictures and/or videotape the students throughout the event.  These pictures and video materials may be posted online on the site http://detskiyzhurnal.org, and pictures may be published in the magazine Malenkaya Kompaniya. 
A few may also be used for publicity, including electronic publications and blogs, or in audiovisual presentations, promotional literature, advertising materials, or in any other similar manner.

Please sign and return the registration and permission slip with your payment ($45 per child and $5 per adult). Thank you for your support.

  _____________________________                                ______________________
       Signature of Parent/Guardian                                                          Date