Student Re-Registration Form

Lathrop School of Dance STUDENT PHOTO RELEASE FORM

Student’s Name: ______

Parent/Guardian Name: ______

Address: ______

Phone #: ______

Email:

______Student or Parent/Guardian (if under 18) Signature

I give permission for my child's or my picture to be used in publicity and school publications. I understand that this may include Internet based advertising and the dance school website. Please return upon registering. I will provide a letter/email ([email protected]) by October 30, 2012 if I do NOT wish to give my consent.

Lathrop School of Dance STUDENT PHOTO RELEASE FORM

Student’s Name: ______

Parent/Guardian Name: ______

Address: ______

Phone #: ______

Email:

______Student or Parent/Guardian (if under 18)Signature

I give permission for my child's or my picture to be used in publicity and school publications. I understand that this may include Internet based advertising and the dance school website. Please return upon registering. I will provide a letter/email ([email protected]) by October 30, 2012 if I do NOT wish to give my consent.