Student Name
*
First Name
Last Name
I give permission for my child to appear in videos, audio recordings, films, photographs, written articles, or on websites and social media sites.
*
Yes
No
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent Name
*
First Name
Last Name
Parent Signature
*
Submit
Submit
Should be Empty: