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Parent's First Name:
Parent's Last Name:
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Weight (in pounds):
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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:
(No 1 is needed before the area code)
Secondary Phone:
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Confirm Email:
City Talent Resides In:

All links should be in URL form



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Are you or your child currently represented by any other agency or manager? If so, please list them and the respective division (all, theatrical, commercial, Etc):

What else would you like to tell us...

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Agreement REQUIRED

By checking this box you signify that you have answered these questions honestly. By submitting, you are confirming that you or your child has a valid Social Security number and can work legally in the United States unless your child is a newborn and a social is in process. Please add to your address book or safe sender list to ensure email delivery. Please also check your spam or junk filter if you do not hear from us in a reasonable period of time.

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Paloma Jackson ~ 1500 Rosecrans Avenue, Suite 500 ~ Manhattan Beach, CA 90266
ph 323.800.7500 ~ fax 323.800.7250 ~