Form D                 

Permission Form

Name of School District______________________________________________________________

Name of School____________________________________________________________________

Type of Winner (class, school, district)___________________________________________________

Please complete the following information for your student:

Name of Student___________________________________________________________________

Name of Parent____________________________________________________________________

Family's Address___________________________________________________________________

Home Phone______________________________________________________________________

Name of Classroom Teacher__________________________________________________________

Student's Signature_________________________________________________________________

I hereby give the school coordinator permission to submit my child's name for recognition in local newspapers.

Parent's Signature___________________________________________________________________

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