By initialing here, I give permission for my son/daughter to be interviewed, photographed, and/or videotaped while participating in the Expanded Learning Program. I am aware there are times the program may be featured in news stories and reporters, photographers, and/or film crews from television, radio stations, and newspapers may wish to interview my son/daughter. I understand that such photographs, video recordings, and/or reports will be property of the Expanded Learning and may be used ONLY for the purpose of documenting or publicizing the Expanded Learning Program through print, web, and social media.
I declare that I am the parent/legal guardian of the named student and the information on this three-page application is true and correct. I will notify the Expanded Learning Program if there are changes to any information stated in the application.
Parent/Guardian Signature