MUSIC AND THE BRAIN @HOME

ALL-STAR CHALLENGE PERMISSION FORM

PARENT/GUARDIAN INFORMATION:

Parent/Garduian's Name

Parent/Guardian's E-mail

Parent/Guardian's Address

STUDENT INFORMATION:

Student's Name

Student's School

Student's Grade

Student's City

Music Teacher's Name

SUBMISSION:

Upload your All-Star Challenge work here. Files may not exceed 15MB in size. Video files may need to be trimmed to under 45 seconds, depending on the file type.

Upload File

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TERMS & CONDITIONS:

I hereby consent to participation in matb-at-home.org challenges, the use of interview quotes, photographs, movies and/or videotapes of the student named above by Music and the Brain/Building for the Arts. I also grant Music and the Brain/Building for the Arts the right to edit, use and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release my child’s school district and it’s agents and
employees of all claims, demands, and liabilities whatsoever in connection with the above.

I agree to the terms & conditions

Parent Signature

Thanks for submitting!