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Parent/Guardian/Legal Representative's Name
Minor Child's Name
I am the parent/guardian/legal representative of this Minor Child and do hereby give permission
for the above-named minor child (hereinafter “Minor”) to be interviewed, photographed, and/or recorded by Sparkler or its representatives. I understand and agree that the text, photographs, and/or video/audio recordings containing the words, image and/or voice of the Minor may be used in the production of instructional and/or promotional materials produced by or on behalf of Sparkler Learning (hereinafter the “Program”) and that such materials may be distributed or broadcast to the public and displayed publicly. I also understand that my permission to use the text, photographs and recordings is for an unlimited duration and that neither I nor the Minor will receive any compensation for granting this permission or for the use, if any, by Sparkler of the Minor’s words, image and/or voice.

I acknowledge that Sparkler has no obligation to use the Minor’s words, images, or voice in connection with the Program.

I hereby unconditionally release Sparkler and its representatives from any and all claims and demands arising out of the activities authorized under the terms of this agreement.

By signing below, I represent that I am at least 18 years of age and am the parent/guardian/legal representative of the above-named Minor. I have read the foregoing agreement and am familiar with all of the terms and conditions thereof and I consent to its execution by the Minor. I agree that neither I nor the Minor will revoke or disaffirm this agreement at any time.
Relationship to Minor
MM/DD/YYYY

Contact Information

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