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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

Upload supported file (Max 15MB)

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!

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