First Name *

Last Name *

Email *

Phone

Address

Social Media Handles

Instagram *

Facebook *

Pinterest *

Information about your kids (Please include names and ages.) *

What are your children's favourite toys to play with and their interests. (This will better help us select toys for sampling).

Please complete the photo release waiver below. This must be completed before any samples are shipped to you.

Your Name *

hereby grant and authorize Chalk and Chuckles Products Pvt. Ltd. the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all video and photography taken of me or my child(ren) to be used in and/or for any lawful purpose.

This authorization extends to all languages, media, formats, and markets now known or later discovered.

This authorization shall continue indefinitely unless I otherwise revoke this authorization in writing.

I waive the right to inspect or approve any finished product in which my likeness appears.

I agree that I have been compensated for this use of my likeness or have otherwise agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the videos or photographs.

I understand and agree that the materials shall become the property of Chalk and Chuckles Products Pvt. Ltd and will not be returned.

I hereby hold harmless and release Chalk and Chuckles Products Pvt. Ltd from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

Printed Name:

Printed First Name *

Printes Last Name *

Date

Signature *

Product samples are chosen based on the best age appropriate toysegyptian-geranium-essential-oil for your children, and the needs of our Marketing Department. Special requests can be made and will be considered.

Request for specific product or category.

Mailing Address for Shipment *

Street Address

Street Address Line 2

City

State

Postal Code

Phone Number *

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We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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