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Hazleton Area School District Media Release for Music Students
Please read the following Media Consent and Release, complete the questions below, and click submit.
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Email
*
Your email
Date
*
MM
/
DD
/
YYYY
Please make your selection:
*
Choose
Yes, I approve the above Media Consent and Liability Statement for my child.
No, I do not approve the above Media Consent and Liability Statement for my child.
Student Name
*
Your answer
Student Grade
*
Choose
4
5
6
7
8
Student School
*
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Drums EMS
Freeland EMS
Hazleton EMS
Heights-Terrace EMS
Maple Manor EMS
McAdoo-Kelayres EMS
Valley EMS
West Hazleton EMS
Parent/Guardian Name
*
Your name will be considered as your signature.
Your answer
Parent/Guardian Address
*
Your answer
Parent/Guardian Home/Cell Phone Number
*
Your answer
Parent/Guardian Email Address
*
Your answer
A copy of your responses will be emailed to the address you provided.
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