Be in the shot

Name *

First Name

Last Name

Phone

(###)

###

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Certify Particpation *

I Agree that

I am participating in the filming of WLWT Let's Talk Cincy at my own risk. Neither Skate Downtown Cincy nor WLWT are responsible for accidents & I will sign a Cincy Parks Skate Waiver upon arrival at the rink.

I will participate at the date and time agreed upon or supply ample notice if my attendance plans change.