Photo Release
This form can be used for up to 4 students.
Parent/Guardians Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Student's Name
*
First Name
Last Name
Date of Birth
Student's Name
First Name
Last Name
Date of Birth
Student's Name
First Name
Last Name
Date of Birth
Student's Name
First Name
Last Name
Date of Birth
I give my permission for my child(ren) and artwork to be photographed at White Bear Center for the Arts and I agree that these images may be used for publicity and promotion purposes in printed materials and on the website. Full names will not be used, under any circumstance unless otherwise requested. Pictures may include first names on name tags students may be wearing in photos.
Yes!
I do not want my child(ren) photo to be used, but I give permission for my child(s) artwork to be used for promotional purposes on the WBCA website, catalog, and or other printed materials for publicity.
No
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Emergency Contact Information
Please list at least 1 emergency contact
Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Relationship to Student
*
Emergency Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship to Student
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