Individual Student Registration Form & Waiver printable pdf download

Individual Student Registration Form & Waiver

INDIVIDUAL STUDENT REGISTRATION FORM & WAIVER

Date _____________

Please be advised that your child may be photographed, videotaped, or interviewed for the purpose of

their project School Art for Mankind. With your consent, the photographs, videos or interviews may be

reproduced and released for use in the media, i.e., newspapers, brochures, videos, television, internet,

Miami-Dade County Public Schools & SAM websites, and social media platforms such as Facebook, Twitter,

Instagram, etc…

Please print legibly. This form should accompany all project submissions

ARTIST (Student)

Artist Name: ______________________________

Grade: ________________________________

School Name: _____________________________

Team Name: ___________________________

Teacher Name: ____________________________

PARENTS

Parent Name: _____________________________

Parent Phone: __________________________

Parent Email: _____________________________

Address: _______________________________

City: _____________________________________

Zip: ___________________________________

☐ Yes.

My child may participate to the School Art for Mankind Contest

☐ Yes.

My child’s photograph/video/interview may be reproduced and released for use in the

media

☐ No.

My child’s photograph/video/interview may not be reproduced and released for use in

the media

Signature: _______________________________

Date: __________________________________

Individual Student Registration Form & Waiver