Alpha Media Release

Alpha Media Release

2022 Oratorical Contest
Student Name *

First Name Last Name
Student Email *

Confirmation Email example@example.com
Student Phone *
Please enter a valid phone number.
The student is

Younger than 18 18 or older
Age Consent *
Please Consent The Students Age
Granting permission for {studentName}
Parent:
This section must be completed by the parent or guardain only, this release will be confirmed by the committee.
Parent Name

First Name Last Name
Parent Email

Confirmation Email example@example.com
Parent Phone
No Dashes or Spaces Allowed
I, undersigned, agree with the selected statement:

I grant permission the student to participate and appear in video or audio recording, films, photographs, written articles, or on websites and social media sites. I do not consent to use of the student's photograph, voice, and/or name in various media projects.
Date

Month Day Year
Date
Parent Signature

Clear
Student Signature

Clear
Should be Empty: