Media Release Waiver
In order to accept this waiver as a valid response all fields below must be filled in. All your information will be kept confidential and is for recording purposes only. Your information will not be distributed or sold. Your information is used to complete the waver and to confirm the identity of the person(s) signing the waiver. Parental approval may be required if the parent(s) has/have requested that the school receive approval from them first. This form will only be used as a consent form for appearance in summit instructional videos. No confidential or private information about an individual given to us in this form will be released or leave the school. However your information may be seen/reviewed by administrative staff or peers involved in the summit video creation and administration processes. Regardless, your information will remain confidential.
Student's First Name *
Student's Last Name *
Student's ID *
Parent's Email Address *
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