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Media Release Form LBUSD
Lakewood HS Music Department
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Student Media Authorization and Release
Student Name (First and Last)
*
Your answer
Student ID #
*
Your answer
Parent/Guardian Electronic Signature (Typing your name here constitutes a legal signature of an adult, 18 or older.)
*
Your answer
Date
*
MM
/
DD
/
YYYY
Parent/Guardian Telephone Number
*
Your answer
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