McKean Band Program

Web Publication Consent Form

I understand that my child’s creative, academic, or athletic work and/or achievements may be eligible to appear on the McKean Band web site. I allow the following information about my child to appear on the McKean Band web site (check all that apply):

___ My child’s first name and last initial only (no picture)

___ My child’s first name and last name (no picture)

___ My child’s individual picture with name

___ My child’s individual picture without name

___ My child’s picture in a group with name

___ My child’s picture in a group without name

___ My child’s creative, academic, or athletic work and/or achievements

Parent/Guardian (or student if 18):

______________________________

Signature

______________________________

Print Name

Witness:

______________________________