ESD 123 Middle School Student Release Form

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Educational Service District 123 proudly hosts an annual regional Middle School Art Exhibit. This is a non-juried art show aimed at showcasing the artistic talents of students in grades 6-8. Learn more about the art exhibit, including entry guidelines, at www.esd123.org/programs__services/art_show/middle_school_art

Please Note: This signed form must accompany artwork submitted by each participating student. Please fill out, sign, and submit.

Contact Lori Ballard (lballard@esd123.org) or Molly Curtiss (mcurtiss@esd123.org) if you have any questions.

Releases and Permissions:

Please read carefully.

1. PERMISSION TO DISPLAY ARTWORK ON WEBSITE AND IN PUBLICATIONS
I acknowledge and understand that the ESD may showcase all entries to this Art Show in various multimedia formats including, but not limited to, their websites. This information will be open to public view and may include my first name, last name, school/district, title of entry, medium, and inspiration and/or description.

2. RELEASE AND UNDERSTANDING
We/I, the undersigned, grant consent for public display of the art entry and release the ESD from all liability for damage, loss or misappropriation. In signing this release, I give the ESD or any organization acting on its behalf the right to use, publish, display and/or reproduce any video/recorded voice/photographs in which I may appear, without payment.

3. PHOTO/VIDEO RELEASE
The ESD is dedicated to supporting teaching and learning in the State of Washington. This includes developing websites, publications, and informational materials. In this work, there will be opportunities for people to be interviewed, photographed, and/or videotaped. I understand and agree that these materials (interviews, photographs, videos, recordings) will become the property of ESD 123 and will not be returned. I also authorize ESD 123 to edit, alter, copy, exhibit, publish, or distribute this video/recorded voice/photograph for educational purposes or any other lawful purpose. In addition, we/I give permission to use likeness/voice of participant along with full name.

Printed Name of Student *

What school does your student attend? *

Date *

YYYY

Who is submitting the consent form? *

I hereby certify that I am the parent or legal guardian of the student named above and give my consent.

I hereby certify that I am the teacher of the student named above and give my consent.

Signature *

Type your full name in the space below to certify that you are the parent, legal guardian, or teacher of the student name above.

Date *

YYYY

Submit

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