Consent Form Example

U.S. Department of Education Parental Consent Form

As an entrant in the U.S. Department of Education’s (Department’s) “[TBD]” Contest, I certify I am the creator of the entry entitled “_______________” that I submitted as part of the foregoing contest. I attest that all statements made in the entry are true to the best of my knowledge.

I understand that a panel of judges has evaluated my entry and judged it to be one of the finalists. By signing below, my parent (if a minor) and I hereby give permission for my entry to be showcased by the Department via [TBD] where it will be voted on by (re)viewers. By signing below, my parent (if a minor) and I also grant the Department permission to post my entry for purposes of the contest, without payment or any other consideration. Further, by signing below, my parent (if a minor) and I understand and agree that my entry will become the property of the Department of Education and will not be returned.

I understand that if my entry is voted to be a potential winner, then I will be eligible for a [TBD] prize. In the event that I am declared a winner, by signing below, my parent (if a minor) and I hereby provide written consent to the Department to disclose my entry, name, city and state of residence and school name to the public for purposes of publicizing the award, the Department’s programs, or both.

By signing below, my parent (if a minor) and I irrevocably authorize the Department of Education to edit, alter, copy, exhibit, publish or distribute this entry for purposes of publicizing the Department’s programs or for any other lawful purpose. In addition, by signing below, my parent (if a minor) and I waive the right to inspect or approve the finished product, including written or electronic copy. Additionally, by signing below, my parent (if a minor) and I waive any right to royalties or other compensation arising or related to the use of the video.

By signing below, my parent (if a minor) and I hereby agree to hold harmless and release and forever discharge the Department from all claims, demands, and causes of action which I, my guardians, heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

My parent (if a minor) and I have read this release before signing below and fully understand the contents, meaning, and impact of this release.

_____________________________________________ ________________________ (Signature) (Date)

Student

______________________________________________________ _____________________________

(Printed Name) (Date)

_____________________________________________ ________________________ (Signature) (Date)

Parent of Student under 18

______________________________________________________ _____________________________

(Printed Name) (Date)