GForce STEM Club Media Release Form

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By signing below, I give permission for my child’s name/image to be used by the GForce STEM Club (a division of Springwall Learning Solutions) for all social media platforms and our websites. The appearance could include name, photo, video, and/or resemblance. I also grant permission for the GForce STEM Club to publish positive, educational content created by my child. *Below please specify if you agree to the terms above and fill out all additional information.*

I agree to the terms above.

Yes

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Parent Name (First, Last) *

Parent Telephone Number *

Student Name 1 (First, Last) *

Student Name 2 (First, Last)

Student Name 3 (First, Last)

Date (XX/XX/XXXX) *

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