WEBSITE IMAGE AND VIDEO CONSENT FORM

By signing the form below, as a legal guardian to the referenced minor, I give my consent for video and/or images captured during a Private Lesson with DallasGoalie.com or Konstantin Kovalenko to be utilized online by DallasGoalie.com, Konstantin Kovalenko and/or Standard Design Co for training, marketing or general use.

DallasGoalie.com, Konstantin Kovalenko and/or Standard Design Co.

Guardian Name

First Name

Last Name

Minors Name

Email Address

Phone

(###)

###

####

I agree and consent to the use of video or images as described above