Media Release & Permission PhoneThis field is for validation purposes and should be left unchanged.I grant media release and permission to use my student’s name and reproduction of physical likeness for the purpose of publicizing the program through pamphlets, video, newspaper, periodicals, etc. I also grant permission and agree to let my student participate in the activites described.Media Release & Permission I have read and understand the above school permission and agree to let my student participate in the activities described.Name of Student(Required) Full Name Name of Parent/Guardian(Required) Full Name Date MM slash DD slash YYYY Δ
