Nimitz Dance Department Media Release Form
This is the media release form for the Dance Department of Nimitz High School in Irving ISD, Irving, Texas. Your electronic signature on this form will serve as a media release for the school year in which it is completed. For questions, contact the Nimitz HS dance director directly:

Chely Seels 
Nimitz HS Dance Teacher
Vikas Dance Team Director
Kings Dance Crew Director

cseels@irvingisd.net
972-600-5750 (office)
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Email *
Student Last Name *
Student First Name *
Student I.D. Number *
Student Email Address *
Student Cell Phone Number *
Student Organization/Affiliation *
Parent / Guardian Last Name *
Parent / Guardian First Name *
Parent / Guardian Email Address *
Parent / Guardian Cell Phone Number *
I give the Nimitz High School Dance Department (Irving ISD) and its employees, representatives, and authorized media organizations permission to print, photograph, record, and live-stream my child for use in audio, video, film, live-stream / broadcast, and any other electronic, digital, and printed media. Furthermore, I agree that my electronic signature on this form is valid for the school year in which it was completed. I give consent without compensation to me or to my child. All negatives and positives, prints, video-recorded images and audio recordings shall constitute the property of Nimitz High School Dance Department solely and completely. *
Parent / Guardian Electronic Signature *
Student Electronic Signature *
Today's Date *
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