Product Name:

[Product Name]

Campaign Title:

Media Type(s):

• Television

•  Online

•  Print

•  Radio

• Other: _______________

Target Age Group:

• 0-3 years

• 4-7 years

• 8-12 years

Ad Duration (if applicable):

Ad Release Date:

End Date of Campaign:

Primary Message of the Ad:

Fun and educational playtime with [Product Name].

Educational Value (if applicable):

Does the Ad include any celebrities or influencers?

• Yes

• No

Does the Ad encourage positive social values?

• Yes

•  No

Is the Ad-free from any form of direct solicitation to children?

• Yes

•  No

Does the Ad differentiate between reality and fantasy?

• Yes

•  No

Initial Review Date: 

[Month Day, Year]

Expected Completion Date: 

Reviewer's Name: 

Reviewer's Comments Section: