| Holifield Photography

SCAPA Parent Permission

Student Name *

First

Last

Address *

City *

Zip *

Parent/Guardian Name #1 *

First

Last

Phone Number #1 *

Email #1 *

Parent/Guardian Name #2

First

Last

Phone Number #2

Email #2

Enter up to 10 items for your student biography in the fields below. No additional items may be added to the biography after being submitted.

Please make sure all spelling is correct.

Student's Name (As it should be used for display) *

SCAPA Major *

SCAPA Minor *

Lines 1-10 *

Holifield Photography is not responsible for the accuracy of spelling, sentence structure or punctuation within the biography. Parents should proofread the biography for accuracy and make needed changes before it is submitted. Once the biography is submitted with the application it may not be changed and it will appear exactly as submitted. *

Type “Yes” and your name (must be parent or guardian of student)

The information contained herein is correct. I hereby give consent for all information provided herein and photographs taken of the student to be used for publicity/social media/web site, and display in school/community by Holifield Photography. I hereby release Holifield Photography, their employees and volunteers, from any liability resulting from injuries or illness sustained while participating in this program. *

Type “Yes” and your name (must be parent or guardian of student)

Phone