Student Waivers (under 18)

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Student's Name
Parent/Guardian Name (printed):
Parent/Guardian Signature
Parent/Guardian Signature
VIDEO AND PHOTOGRAPHY WAIVER. I do or do not (please select one) consent to have my student photographed and/or videotaped while participating in classes and programs at Pathlight’s Whole Children and Milestones Recreation programs. I understand that the photos and videos may be used for educational purposes, or for publication, including use on the internet.
Parent/Guardian Signature