FLVS Media Release

Student Name: Student Name: * First Last
Parent Name: Parent Name: * First Last
Email Address: *
Current Grade Level: *
Student FLVS Username: *
I am the parent, legal guardian, or authorized representative of the student named above. I represent and warrant that I have the full legal authority to enter into this Agreement. I have read the information regarding the display of student work.
(Type full name below) *
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Date: Date: * / MM / DD YYYY