Parental/Guardian Consent Form

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Parent/Guardian must submit a fully completed copy of this document in order for their child's video entry to be valid.

Title of Video Entry *

Contestant's (Child's) Name *

Parent/Guardian's Name *

Parent/Guardian - I have read and understand the full Official Rules and Guidelines of the contest. I understand that in the event my child's submission is selected as a winning entry, and the rights and/or originality of my entry cannot be verified to the satisfaction of the judges, an alternate winner may be selected in his/her place. I understand my child has submitted an original video to "An Artistic Salute to the Harlem Renaissance" student video contest. I grant full permission and authority to Alpha Alpha Omicron Omega Chapter and anyone authorized by the organization, to use, publish, and display my or my child’s image and/or voice as it is contained in the video on any medial platform. *

Be selecting this checkbox, I acknowledge the agreement above.

Required

Parent/Guardian - In the event that my child is selected as the Grand Prize Winner, I understand and agree that neither Alpha Alpha Omicron Omega Chapter, nor any member of Alpha Alpha Omicron Omega Chapter has any responsibility in transporting or providing access for my child to attend (physically or virtually) the Summer Enrichment Youth Dance Workshop 2021 at Dallas Black Dance Theatre. *

Be selecting this checkbox, I acknowledge the agreement above.

Required

Please enter today's date. *

YYYY

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