Parent/Legal Guardian: I have reviewed and certify that the application and the statements are accurate and complete to the best of my knowledge. I also agree to the above, that my child’s name and image may be used in any and all media for acknowledgement and publicity purposes, without payment or any consideration and without notifying me.
I/We hereby further certify that I/we am/are the parent(s)/guardian(s) of the person named above.
I/We do hereby give my/our consent, without reservation, to the foregoing on behalf of my/our daughter.
Parent/Legal Guardian Signature: