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Division of Labor Standards - Child Performer Andrew M. Cuomo, Governor | Peter M. Rivera, Commissioner

Application for a 15-Day Child Performer Permit

1. Child Performer Name
2. Child Performer Professional Name (if different)
3. Permit Use (Select all that apply): *
5A. Other Identification Number (for non-US citizens)
6. Physical Description
7. Parent/Guardian Name
8.Primary Phone Number:
Is this number outside of the US?
10. Address
10A. Mail Permit to (if different)
11. Acknowledgement and Declaration: *
12. Sign and Date