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* Teens (13-18)

First name:
Last name:
Parent's First Name:
Parent's Last Name:
Eye Color:
Hair Color:
Birth Date:
Height:
Weight (in pounds):
Gender:
Clothing Size:
Shoe Size:
Ethnicity 1:
Ethnicity 2:
Ethnicity 3:
Ethnicity Specification
"If Hispanic, Asian, or Pacific Islander, please specify associated country. We often get very specific
requests (e.g. - Korean, Guatemalan, Filipino)":

Cell Phone:
Secondary Phone:
Email:
Confirm Email:
City Talent Resides In:

Is your child currently represented by any other agency or manager? If so, please list them and cite in what area they represent your child (all, theatrical, commercial, Etc):

What else would you like to tell us...

Picture 1:
Picture 2:
Picture 3:
Picture 4:
Picture 5:

Agreement REQUIRED

By checking this box you signify that you have answered these questions honestly. You also signify that if this child submitted herein for representation was formerly represented by Paloma Jackson at Jet Set World, LLC or Jet Set Enterprises, LLC, you hereby acknowledge that neither you nor this child were solicited by Paloma Jackson to submit for representation by Paloma Model & Talent, Inc.

I agree to the terms


Submit

Paloma Jackson ~ 1500 Rosecrans Avenue, Suite 500 ~ Manhattan Beach, CA 90266
ph 323.800.7500 ~ fax 323.800.7250 ~ info@palomamodelandtalent.com