Media Waiver - Minnesota MATHCOUNTS
I give my consent to Minnesota MATHCOUNTS/Engineering Alliance Foundation Minnesota and Engineering Alliance Minnesota to use the student’s name, comments, photographic image, video and likeness online and in print materials in order to promote MATHCOUNTS in Minnesota.

I also understand that I will not have the opportunity to review or inspect such comments, images, video and likeness prior to posting online or appearing in printed materials.  

I further understand that the student may be called upon by journalists to answer questions about his or her involvement in this program and I also will allow the student to speak to any media via phone or in person about this program.

Sign in to Google to save your progress. Learn more
Email *
After submitting this form, please forward the confirmation to your student's coach for their confirmation.
Questions can be directed to katie@mathcountsmn.org
Date *
MM
/
DD
/
YYYY
School name *
Student's First Name *
Student's Last Name *
Student's Gender
Clear selection
Student's Grade
Clear selection
Teacher name *
Parent/Guardian Name *
I certify that I am the legal guardian of the student with the right to give this consent. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms