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Parent's First Name:
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Birth Date:
Height:
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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:
(No 1 is needed before the area code)
Secondary Phone:
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Email:
Confirm Email:
City Talent Resides In:


All links should be in URL form
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IMDB:

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Personal Webpage:

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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 submissions@palomamodelandtalent.com 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 ~ info@palomamodelandtalent.com